Acspc 047079

Cancer Facts
&Figures 2016
WA
37,770 NH
MT 8,680 ME
ND VT
6,070 9,270
3,930 MN 4,050
OR
29,130
22,510 MA
ID
SD WI NY 37,620
8,120
4,690 32,970 110,280
WY RI
MI
2,920 6,190
56,530
IA PA
NV NE 17,100 83,560 CT 21,700
14,390 9,740 OH NJ 49,750
UT IL IN 66,020
CA 11,030 65,090 35,180 DE 5,630
CO WV
173,200 24,730 KS 11,770 VA MD 30,990
MO 43,190
14,530 KY
34,270 DC 2,910
25,720
NC
TN 54,450
AZ OK 37,650
32,510 NM 19,650 AR SC
9,750 16,460 27,980
MS AL GA
16,680 27,020 48,670
TX
116,690 LA
25,070
AK
3,330 FL
121,240
US
1,685,210
PR
HI N/A
6,850
Estimated numbers of new cancer cases for 2016, excluding basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Estimates are not available for Puerto Rico.
Note: State estimates are offered as a rough guide and should be interpreted with caution. State estimates may not add to US total due to rounding.
Special Section: Cancer in Asian Americans,

Native Hawaiians, and Pacific Islanders
see page 25
Contents
Basic Cancer Facts 1
Figure 1. Trends in Age-adjusted Cancer Death Rates by Site, Males, US, 1930-2012 2
Figure 2. Trends in Age-adjusted Cancer Death Rates by Site, Females, US, 1930-2012 3
Table 1. Estimated Number of New Cancer Cases and Deaths by Sex, US, 2016 4
Table 2. Estimated Number of New Cases for Selected Cancers by State, US, 2016 5
Table 3. Estimated Number of Deaths for Selected Cancers by State, US, 2016 6
Table 4. Incidence Rates for Selected Cancers by State, US, 2008-2012 7
Table 5. Death Rates for Selected Cancers by State, US, 2008-2012 8
Selected Cancers 9
Figure 3. Leading Sites of New Cancer Cases and Deaths 2016 Estimates 10
Table 6. Probability (%) of Developing Invasive Cancer during Selected Age Intervals by Sex, US, 2010-2012 14
Table 7. Trends in 5-year Relative Survival Rates (%) by Race, US, 1975-2011 18
Table 8. Five-year Relative Survival Rates (%) by Stage at Diagnosis, US, 2005-2011 21

Native Hawaiians, and Pacific Islanders 25
Tobacco Use 43
Figure 4. Number and Percentage (%) of Cancer Deaths Attributable to Cigarette Smoking in 2011,
Adults 35 Years and Older 43
Nutrition & Physical Activity 47
Cancer Disparities 50
Table 9. Incidence and Death Rates for Selected Cancers by Site, Race, and Ethnicity, US, 2008-2012 51
Figure 5. Geographic Patterns in Lung Cancer Death Rates by State, US, 2008-2012 52
The Global Fight against Cancer 53
The American Cancer Society 55
Sources of Statistics 64
American Cancer Society Recommendations for the Early Detection of Cancer in Average-risk
Asymptomatic People 66
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or portions thereof in any form.
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This publication attempts to summarize current scientific information about cancer.

Except when specified, it does not represent the official policy of the American Cancer Society.
Suggested citation: American Cancer Society. Cancer Facts & Figures 2016. Atlanta: American Cancer Society; 2016.
How Many People Alive Today Have
Basic Cancer Facts Ever Had Cancer?
Nearly 14.5 million Americans with a history of cancer were alive
on January 1, 2014. Some of these individuals were diagnosed
What Is Cancer? recently and undergoing treatment, while most were diagnosed
Cancer is a group of diseases characterized by the uncontrolled many years ago with no current evidence of cancer.
growth and spread of abnormal cells. If the spread is not con-
trolled, it can result in death. Cancer is caused by external
factors, such as tobacco, infectious organisms, and an unhealthy
How Many New Cases and Deaths
diet, and internal factors, such as inherited genetic mutations, Are Expected to Occur This Year?
hormones, and immune conditions. These factors may act About 1,685,210 new cancer cases are expected to be diagnosed
together or in sequence to cause cancer. Ten or more years often in 2016 (Table 1, page 4). This estimate does not include car-
pass between exposure to external factors and detectable can- cinoma in situ (noninvasive cancer) of any site except urinary
cer. Treatments include surgery, radiation, chemotherapy, bladder, nor does it include basal cell or squamous cell skin can-
hormone therapy, immune therapy, and targeted therapy (drugs cers because these are not required to be reported to cancer
that interfere specifically with cancer cell growth). registries. Table 2 (page 5) provides estimated new cancer
cases in 2016 by state.
Can Cancer Be Prevented? About 595,690 Americans are expected to die of cancer in 2016,
A substantial proportion of cancers could be prevented. All can- which translates to about 1,630 people per day (Table 1, page
cers caused by tobacco use and heavy alcohol consumption 4). Cancer is the second most common cause of death in the
could be prevented completely. In 2016, about 188,800 of the esti- US, exceeded only by heart disease, and accounts for nearly 1 of
mated 595,690 cancer deaths in the US will be caused by cigarette every 4 deaths. Table 3 (page 6) provides estimated cancer
smoking, according to a recent study by American Cancer Soci- deaths by state in 2016.
ety epidemiologists. In addition, the World Cancer Research
Fund estimates that about 20% of all cancers diagnosed in the How Much Progress Has Been Made
US are related to body fatness, physical inactivity, excess alcohol
consumption, and/or poor nutrition, and thus could also be pre-
in the Fight against Cancer?
vented. Certain cancers are related to infectious agents, such as Trends in cancer death rates are the best measure of progress
human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis against cancer. The total cancer death rate rose for most of the
C virus (HCV), human immunodeficiency virus (HIV), and Heli- 20th century because of the tobacco epidemic, peaking in 1991
cobacter pylori (H. pylori). Many of these cancers could be avoided at 215 cancer deaths per 100,000 persons. However, from 1991 to
by preventing these infections through behavioral changes or 2012, the rate dropped 23% because of reductions in smoking, as
vaccination, or by treating the infection. Many of the more than well as improvements in early detection and treatment. This
5 million skin cancer cases that are diagnosed annually could be decline translates into the avoidance of more than 1.7 million
prevented by protecting skin from excessive sun exposure and cancer deaths. Death rates are declining for all four of the most
not using indoor tanning devices. common cancer types lung, colorectal, breast, and prostate
(Figure 1, page 2 and Figure 2, page 3).
Screening can prevent colorectal and cervical cancers by allow-
ing for the detection and removal of precancerous lesions.
Screening also offers the opportunity to detect some cancers Do Cancer Incidence and Death Rates
early, when treatment is less extensive and more likely to be suc- Vary By State?
cessful. Screening is known to help reduce mortality for cancers Tables 4 (page 7) and 5 (page 8) provide average annual
of the breast, colon, rectum, cervix, and lung (among long-term incidence and death rates during 2008 to 2012 for selected cancer
and/or heavy smokers). In addition, a heightened awareness of types by state. For some cancers (e.g., lung), there is substantial
changes in certain parts of the body, such as the breast, skin, variation by state, whereas for others (e.g., breast), there is less
mouth, eyes, or genitalia, may also result in the early detection of variation. For more information about geographic disparities in
cancer. For complete cancer screening guidelines, see page 66. cancer occurrence, see page 53.
Who Is at Risk of Developing Cancer?

Cancer usually develops in older people; 86% of all cancers in the
United States are diagnosed in people 50 years of age or older.
Cancer Facts&Figures 20161

Certain behaviors also increase risk, such as smoking, eating an familial cancers arise from the interplay between common gene
unhealthy diet, or not being physically active. Cancer research- variations and lifestyle/environmental risk factors. Only a small
ers use the word risk in different ways, most commonly proportion of cancers are strongly hereditary, that is, caused by
expressing risk as lifetime risk or relative risk. Lifetime risk an inherited genetic alteration that confers a very high risk.
refers to the probability that an individual will develop or die
from cancer over the course of a lifetime. In the US, the lifetime
risk of developing cancer is 42% (1 in 2) in men and 38% (1 in 3) in
What Percentage of People
women (Table 6, page 14). These probabilities are estimated Survive Cancer?
based on the overall experience of the general population and The 5-year relative survival rate for all cancers diagnosed dur-
may overestimate or underestimate individual risk because of ing 2005-2011 was 69%, up from 49% during 1975-1977 (Table 7,
differences in exposures (e.g., smoking), family history, and/or page 18). Improvement in survival reflects both the earlier
genetic susceptibility. diagnosis of certain cancers and improvements in treatment.
Survival statistics vary greatly by cancer type and stage at diag-
Relative risk is a measure of the strength of the relationship
nosis (Table 8, page 21).
between a risk factor and cancer. It compares the risk of develop-
ing cancer in people with a certain exposure or trait to the risk in Relative survival is the percentage of people who are alive a des-
people who do not have this characteristic. For example, men and ignated time period (usually 5 years) after a cancer diagnosis
women who smoke are about 25 times more likely to develop lung divided by the percentage expected to be alive in the absence of
cancer than nonsmokers, so their relative risk of lung cancer is cancer based on normal life expectancy. It does not distinguish
25. Most relative risks are not this large. For example, women between patients who have no evidence of cancer and those who
who have a mother, sister, or daughter with a history of breast have relapsed or are still in treatment. The 5-year relative sur-
cancer are about twice as likely to develop breast cancer as vival rate does not represent the proportion of people who are
women who do not have this family history; in other words, their cured because cancer deaths occur beyond 5 years after diagno-
relative risk is about 2. For most types of cancer, risk is higher sis. For information about how survival rates were calculated for
with a family history of the disease. It is now thought that many this report, see Sources of Statistics on page 64.
Figure 1. Trends in Age-adjusted Cancer Death Rates* by Site, Males, US, 1930-2012
100
Lung & bronchus
80
Rate per 100,000 male population
60
Stomach Prostate
Colon & rectum
40
20
Liver Pancreas
Leukemia
0
1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2012
*Per 100,000, age adjusted to the 2000 US standard population. Mortality rates for pancreatic and liver cancers are increasing.
Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung and bronchus, and colon and rectum are affected
by these coding changes.
Source: US Mortality Volumes 1930 to 1959 and US Mortality Data 1960 to 2012, National Center for Health Statistics, Centers for Disease Control and Prevention.
2016, American Cancer Society, Inc., Surveillance Research
2Cancer Facts&Figures 2016

Although relative survival rates provide some indication about staging systems are used to classify cancer. A system of sum-
the average survival experience of cancer patients in a given mary staging is used for descriptive and statistical analysis of
population, they should be interpreted with caution. First, tumor registry data and is particularly useful for looking at
5-year survival rates do not reflect the most recent advances in trends over time. According to this system, if cancer cells are
detection and treatment because they are based on patients who present only in the layer of cells where they developed and have
were diagnosed as far back as 10 years. Second, they are not not spread, the stage is in situ. If cancer cells have penetrated
equally applicable to all patients because of factors that affect beyond the original layer of tissue, the cancer has become inva-
individual survival, such as treatment, other illnesses, and bio- sive and is categorized as local, regional, or distant based on the
logical or behavioral differences. Third, improvements in extent of spread. (For a more detailed description of these cate-
survival rates over time do not always indicate progress against gories, see the footnotes in Table 8 on page 21.)
cancer. For example, increases in average survival time can
Clinicians use a different staging system, called TNM, for most
occur if screening results in the detection of some indolent can-
cancers. The TNM system assesses cancer growth and spread in
cers that would have gone undetected in the absence of screening
3 ways: extent of the primary tumor (T), absence or presence of
(overdiagnosis). Screening also artificially increases survival
regional lymph node involvement (N), and absence or presence
rates when early diagnosis does not extend lifespan.
of distant metastases (M). Once the T, N, and M categories are
determined, a stage of 0, I, II, III, or IV is assigned, with stage 0
How Is Cancer Staged? being in situ, stage I being early, and stage IV being the most
Staging describes the extent or spread of cancer at the time of advanced disease. Some cancers (e.g., lymphoma) have alterna-
diagnosis. Proper staging is essential for optimizing therapy and tive staging systems. As the biology of cancer has become better
assessing prognosis. A cancers stage is based on the size or understood, additional tumor-specific features have been incor-
extent of the primary tumor and whether it has spread to nearby porated into treatment plans and/or stage for some cancers.
lymph nodes or other areas of the body. A number of different
Figure 2. Trends in Age-adjusted Cancer Death Rates* by Site, Females, US, 1930-2012
100
80
Rate per 100,000 female population
60
Lung & bronchus
40
Breast
Colon & rectum
Stomach Uterus
20
Pancreas
Liver
0
1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2012
*Per 100,000, age adjusted to the 2000 US standard population. Uterus refers to uterine cervix and uterine corpus combined. Mortality rates for pancreatic and liver
cancers are increasing.
Note: Due to changes in ICD coding, numerator information has changed over time. Rates for cancers of the liver, lung and bronchus, and colon and rectum are affected
by these coding changes.
Source: US Mortality Volumes 1930 to 1959, US Mortality Data 1960 to 2012, National Center for Health Statistics, Centers for Disease Control and Prevention.

Table 1. Estimated Number* of New Cancer Cases and Deaths by Sex, US, 2016
Estimated New Cases Estimated Deaths
Both sexes Male Female Both sexes Male Female

All Sites 1,685,210 841,390 843,820 595,690 314,290 281,400
Oral cavity & pharynx 48,330 34,780 13,550 9,570 6,910 2,660
Tongue 16,100 11,700 4,400 2,290 1,570 720
Mouth 12,910 7,600 5,310 2,520 1,630 890
Pharynx 16,420 13,350 3,070 3,080 2,400 680
Other oral cavity 2,900 2,130 770 1,680 1,310 370
Digestive system 304,930 172,530 132,400 153,030 88,700 64,330
Esophagus 16,910 13,460 3,450 15,690 12,720 2,970
Stomach 26,370 16,480 9,890 10,730 6,540 4,190
Small intestine 10,090 5,390 4,700 1,330 710 620
Colon 95,270 47,710 47,560 49,190 26,020 23,170
Rectum 39,220 23,110 16,110
Anus, anal canal, & anorectum 8,080 2,920 5,160 1,080 440 640
Liver & intrahepatic bile duct 39,230 28,410 10,820 27,170 18,280 8,890
Gallbladder & other biliary 11,420 5,270 6,150 3,710 1,630 2,080
Pancreas 53,070 27,670 25,400 41,780 21,450 20,330
Other digestive organs 5,270 2,110 3,160 2,350 910 1,440
Respiratory system 243,820 132,620 111,200 162,510 89,320 73,190
Larynx 13,430 10,550 2,880 3,620 2,890 730
Lung & bronchus 224,390 117,920 106,470 158,080 85,920 72,160
Other respiratory organs 6,000 4,150 1,850 810 510 300
Bones & joints 3,300 1,850 1,450 1,490 860 630
Soft tissue (including heart) 12,310 6,980 5,330 4,990 2,680 2,310
Skin (excluding basal & squamous) 83,510 51,650 31,860 13,650 9,330 4,320
Melanoma of the skin 76,380 46,870 29,510 10,130 6,750 3,380
Other nonepithelial skin 7,130 4,780 2,350 3,520 2,580 940
Breast 249,260 2,600 246,660 40,890 440 40,450
Genital system 297,530 191,640 105,890 57,730 26,840 30,890
Uterine cervix 12,990 12,990 4,120 4,120
Uterine corpus 60,050 60,050 10,470 10,470
Ovary 22,280 22,280 14,240 14,240
Vulva 5,950 5,950 1,110 1,110
Vagina & other genital, female 4,620 4,620 950 950
Prostate 180,890 180,890 26,120 26,120
Testis 8,720 8,720 380 380
Penis & other genital, male 2,030 2,030 340 340
Urinary system 143,190 100,920 42,270 31,540 21,600 9,940
Urinary bladder 76,960 58,950 18,010 16,390 11,820 4,570
Kidney & renal pelvis 62,700 39,650 23,050 14,240 9,240 5,000
Ureter & other urinary organs 3,530 2,320 1,210 910 540 370
Eye & orbit 2,810 1,510 1,300 280 150 130
Brain & other nervous system 23,770 13,350 10,420 16,050 9,440 6,610
Endocrine system 66,730 16,200 50,530 2,940 1,400 1,540
Thyroid 64,300 14,950 49,350 1,980 910 1,070
Other endocrine 2,430 1,250 1,180 960 490 470
Lymphoma 81,080 44,960 36,120 21,270 12,160 9,110
Hodgkin lymphoma 8,500 4,790 3,710 1,120 640 480
Non-Hodgkin lymphoma 72,580 40,170 32,410 20,150 11,520 8,630
Myeloma 30,330 17,900 12,430 12,650 6,430 6,220
Leukemia 60,140 34,090 26,050 24,400 14,130 10,270
Acute lymphocytic leukemia 6,590 3,590 3,000 1,430 800 630
Chronic lymphocytic leukemia 18,960 10,830 8,130 4,660 2,880 1,780
Acute myeloid leukemia 19,950 11,130 8,820 10,430 5,950 4,480
Chronic myeloid leukemia 8,220 4,610 3,610 1,070 570 500
Other leukemia 6,420 3,930 2,490 6,810 3,930 2,880
Other & unspecified primary sites 34,170 17,810 16,360 42,700 23,900 18,800
*Rounded to the nearest 10; cases exclude basal cell and squamous cell skin cancer and in situ carcinoma except urinary bladder. About 61,000 cases of carcinoma in
situ of the female breast and 68,480 cases of melanoma in situ will be diagnosed in 2016. Deaths for colon and rectal cancers are combined because a large number of
deaths from rectal cancer are misclassified as colon. More deaths than cases may reflect lack of specificity in recording underlying cause of death on death certificates
and/or an undercount in the case estimate.
Source: Estimated new cases are based on 1998-2012 incidence data reported by the North American Association of Central Cancer Registries (NAACCR). Estimated
deaths are based on 1998-2012 US mortality data, National Center for Health Statistics, Centers for Disease Control and Prevention.

Table 2. Estimated Number* of New Cases for Selected Cancers by State, US, 2016
Melanoma Non-
Female Uterine Colon & Uterine Lung & of the Hodgkin Urinary
State All sites breast cervix rectum corpus Leukemia bronchus skin lymphoma Prostate bladder
Alabama 27,020 3,960 220 2,190 710 900 4,220 1,390 1,030 2,950 1,110
Alaska 3,330 500 270 110 120 440 100 140 330 150
Arizona 32,510 4,900 230 2,550 1,060 1,160 3,980 1,510 1,300 3,150 1,630
Arkansas 16,460 2,090 150 1,410 470 510 2,610 340 670 1,670 700
California 173,200 26,730 1,460 13,770 6,120 6,370 18,140 8,560 7,760 17,240 7,580
Colorado 24,730 4,110 180 1,790 860 1,020 2,520 1,460 1,110 3,060 1,080
Connecticut 21,700 3,290 120 1,610 880 790 2,770 680 920 2,460 1,130
Delaware 5,630 800 430 190 180 850 320 220 690 260
Dist. of Columbia 2,910 470 200 100 80 300 110 110 460 90
Florida 121,240 16,770 1,050 9,710 3,940 3,930 17,360 6,200 5,370 13,310 5,940
Georgia 48,670 7,160 430 3,980 1,450 1,490 6,670 2,540 1,830 5,570 1,830
Hawaii 6,850 1,130 60 650 280 220 740 410 300 610 250
Idaho 8,120 1,110 50 610 280 360 990 490 370 1,010 430
Illinois 65,090 10,160 550 5,580 2,690 2,370 8,820 2,500 2,860 7,250 3,040
Indiana 35,180 4,980 290 2,980 1,310 1,190 5,520 1,460 1,500 3,510 1,620
Iowa 17,100 2,310 110 1,500 700 730 2,420 1,000 790 1,670 840
Kansas 14,530 2,210 110 1,150 560 540 1,970 820 640 1,510 650
Kentucky 25,720 3,470 200 2,200 810 980 4,960 1,450 1,080 2,460 1,120
Louisiana 25,070 3,400 220 2,170 620 710 3,730 620 1,090 2,950 940
Maine 9,270 1,310 50 720 380 380 1,410 340 400 960 570
Maryland 30,990 4,880 230 2,390 1,170 1,000 4,100 1,590 1,230 3,840 1,330
Massachusetts 37,620 6,010 210 2,750 1,560 1,340 4,910 1,380 1,720 4,350 2,030
Michigan 56,530 8,150 380 4,570 2,290 1,890 8,440 2,560 2,520 6,000 3,000
Minnesota 29,130 4,300 140 2,180 1,070 1,280 3,660 1,220 1,370 2,930 1,300
Mississippi 16,680 2,330 150 1,530 430 520 2,550 490 570 1,770 600
Missouri 34,270 5,030 250 2,850 1,250 1,220 5,450 1,610 1,440 3,260 1,550
Montana 6,070 890 460 210 270 750 350 270 770 330
Nebraska 9,740 1,480 60 850 380 390 1,220 470 440 960 460
Nevada 14,390 2,010 110 1,140 390 520 1,700 440 550 1,320 670
New Hampshire 8,680 1,280 620 350 290 1,140 290 350 910 490
New Jersey 49,750 7,420 370 4,020 2,050 1,870 5,580 2,470 2,430 5,970 2,460
New Mexico 9,750 1,480 80 760 330 380 1,020 450 410 1,020 390
New York 110,280 16,360 790 8,730 4,360 4,490 13,200 4,250 4,860 12,010 5,220
North Carolina 54,450 7,830 400 4,280 1,780 1,870 7,870 2,850 2,210 5,990 2,280
North Dakota 3,930 530 310 130 150 480 190 160 400 180
Ohio 66,020 9,390 470 5,340 2,640 2,140 10,550 2,880 2,820 6,760 3,180
Oklahoma 19,650 2,760 180 1,630 590 720 3,150 570 860 2,080 840
Oregon 22,510 3,430 150 1,610 850 750 2,970 1,530 980 2,490 1,130
Pennsylvania 83,560 11,310 540 6,390 3,290 3,020 10,500 3,750 3,540 8,350 4,260
Rhode Island 6,190 940 490 250 210 890 210 260 640 350
South Carolina 27,980 4,010 210 2,220 860 920 4,280 1,540 1,080 3,190 1,210
South Dakota 4,690 680 390 170 180 590 210 210 470 230
Tennessee 37,650 5,420 300 3,130 1,100 1,350 6,010 1,850 1,510 3,370 1,590
Texas 116,690 16,800 1,330 9,680 3,700 4,210 14,620 2,920 5,120 13,210 4,150
Utah 11,030 1,420 70 720 400 470 890 840 510 1,310 430
Vermont 4,050 580 280 160 140 510 180 170 450 220
Virginia 43,190 6,620 300 3,240 1,490 1,310 5,690 2,340 1,660 4,820 1,910
Washington 37,770 5,820 230 2,700 1,390 1,490 4,670 2,440 1,750 4,430 1,830
West Virginia 11,770 1,490 90 1,010 450 410 2,020 640 490 1,030 600
Wisconsin 32,970 4,730 200 2,520 1,310 1,260 4,230 1,350 1,490 3,570 1,630
Wyoming 2,920 420 220 100 110 310 180 120 380 160
United States 1,685,210 246,660 12,990 134,490 60,050 60,140 224,390 76,380 72,580 180,890 76,960
*Rounded to nearest 10. Excludes basal cell and squamous cell skin cancers and in situ carcinomas except urinary bladder. Estimate is fewer than 50 cases.
These estimates are offered as a rough guide and should be interpreted with caution. State estimates may not sum to US total due to rounding and exclusion of state
estimates fewer than 50 cases.
Please note: Estimated cases for additional cancer sites by state can be found in Supplemental Data at cancer.org/statistics.

Table 3. Estimated Number* of Deaths for Selected Cancers by State, US, 2016
Brain/ Non-
nervous Female Colon & Lung & Hodgkin
State All sites system breast rectum Leukemia Liver bronchus lymphoma Ovary Pancreas Prostate
Alabama 10,650 300 670 920 430 420 3,260 340 260 690 470
Alaska 1,070 70 90 50 290 70
Arizona 11,800 360 780 980 510 590 2,830 410 310 900 590
Arkansas 6,830 170 430 600 260 260 2,190 210 150 420 270
California 59,060 1,760 4,400 5,180 2,560 3,600 12,230 2,140 1,530 4,390 3,050
Colorado 7,760 270 560 650 330 370 1,690 260 240 560 430
Connecticut 6,780 190 450 450 310 300 1,690 220 170 540 320
Delaware 2,050 50 130 150 80 100 600 60 50 140 90
Dist. of Columbia 980 90 90 80 210 90 70
Florida 43,600 1,080 2,880 3,500 1,770 1,870 11,960 1,480 940 3,080 1,970
Georgia 16,840 460 1,260 1,500 620 730 4,700 490 420 1,090 730
Hawaii 2,480 130 230 90 150 570 100 50 230 100
Idaho 2,810 90 180 220 120 110 670 100 70 210 160
Illinois 24,080 600 1,660 2,030 1,010 930 6,540 800 570 1,640 1,020
Indiana 13,510 350 860 1,070 570 460 4,020 440 300 860 520
Iowa 6,470 190 380 570 260 230 1,770 250 160 430 280
Kansas 5,540 180 360 460 260 210 1,540 200 130 390 220
Kentucky 10,350 250 600 830 390 360 3,570 330 200 610 340
Louisiana 9,110 220 630 790 330 470 2,620 280 180 650 360
Maine 3,320 90 170 230 140 120 970 120 60 230 130
Maryland 10,560 270 820 850 390 510 2,670 310 260 800 480
Massachusetts 12,630 330 770 890 520 630 3,380 390 330 930 530
Michigan 21,100 610 1,410 1,640 850 800 6,030 780 480 1,520 790
Minnesota 9,850 280 610 750 480 410 2,430 500 240 660 470
Mississippi 6,480 150 420 630 240 280 1,930 170 110 440 280
Missouri 12,970 320 880 1,050 520 550 3,950 370 250 860 470
Montana 2,020 60 130 170 80 70 520 70 60 130 120
Nebraska 3,500 110 210 330 150 130 890 130 70 240 180
Nevada 4,970 150 380 480 180 210 1,390 160 110 360 240
New Hampshire 2,770 80 170 190 110 90 770 80 60 210 130
New Jersey 16,150 400 1,280 1,450 640 670 3,830 510 440 1,260 680
New Mexico 3,690 100 260 350 150 210 790 130 110 240 200
New York 34,910 880 2,410 2,830 1,460 1,650 8,770 1,200 920 2,660 1,550
North Carolina 19,620 600 1,360 1,480 750 830 5,820 610 450 1,240 820
North Dakota 1,270 80 120 50 330 90 60
Ohio 25,510 630 1,700 2,060 1,000 1,020 7,420 850 570 1,800 1,060
Oklahoma 8,260 220 530 690 340 330 2,470 280 190 500 340
Oregon 8,150 240 500 660 340 430 2,100 280 220 570 410
Pennsylvania 28,700 680 1,940 2,340 1,240 1,140 7,530 1,030 700 2,090 1,190
Rhode Island 2,090 50 120 160 90 100 580 60 120 90
South Carolina 10,330 250 690 830 360 420 3,010 310 240 730 450
South Dakota 1,640 50 110 130 70 60 460 50 110 80
Tennessee 14,560 360 900 1,230 550 630 4,610 450 300 870 540
Texas 39,450 1,050 2,780 3,520 1,660 2,470 9,620 1,320 950 2,650 1,520
Utah 2,970 120 270 240 140 130 460 120 90 250 200
Vermont 1,390 50 70 100 50 60 390 100 70
Virginia 14,910 390 1,080 1,160 580 640 4,080 490 390 1,050 630
Washington 12,770 410 820 970 510 660 3,170 440 350 920 630
West Virginia 4,750 120 270 400 180 140 1,460 170 90 270 160
Wisconsin 11,630 350 710 840 540 420 3,060 460 300 840 550
Wyoming 1,000 70 90 50 230 70
United States 595,690 16,050 40,450 49,190 24,400 27,170 158,080 20,150 14,240 41,780 26,120
*Rounded to nearest 10. Estimate is fewer than 50 deaths. Liver includes intrahepatic bile duct.
These estimates are offered as a rough guide and should be interpreted with caution. State estimates may not sum to US total due to rounding and exclusion of state
estimates fewer than 50 deaths.
Please note: Estimated deaths for additional cancer sites by state can be found in Supplemental Data at cancer.org/statistics.

Table 4. Incidence Rates* for Selected Cancers by State, US, 2008-2012
Non-Hodgkin
All sites Breast Colon & rectum Lung & bronchus lymphoma Prostate Urinary bladder
State Male Female Female Male Female Male Female Male Female Male Male Female
Alabama 560.8 398.0 119.5 54.2 38.2 99.2 54.2 19.6 13.7 146.1 33.6 7.5
Alaska 479.3 419.2 125.5 50.5 40.6 74.4 59.9 20.5 14.7 111.8 36.5 10.8
Arizona 420.4 373.9 111.0 40.5 30.9 59.2 47.0 18.3 13.3 89.8 31.9 8.3
Arkansas 550.2 383.7 107.7 54.3 39.4 103.6 59.9 21.5 15.5 148.1 32.9 7.7
California 485.6 394.8 122.1 46.0 35.1 55.8 42.1 22.8 15.5 126.9 32.6 7.8
Colorado 473.7 396.5 125.2 40.0 31.6 52.8 43.3 22.1 15.5 133.2 32.5 8.3
Connecticut 554.4 456.9 137.1 48.2 36.5 72.6 57.6 25.4 17.7 139.9 47.3 12.6
Delaware 578.7 446.3 126.5 45.6 34.9 83.7 63.3 23.4 17.0 156.3 42.3 11.2
Dist. of Columbia 564.1 436.0 141.7 48.6 40.9 74.5 48.7 21.5 12.8 184.1 25.6 8.9
Florida 502.1 400.2 115.2 45.0 34.2 75.8 55.5 21.7 14.9 118.9 34.9 8.4
Georgia 554.5 409.0 123.5 49.6 36.7 89.0 54.1 22.3 14.6 150.1 34.0 8.0
Hawaii 466.5 403.9 130.2 55.1 37.2 59.5 38.4 21.8 14.7 105.0 24.1 6.1
Idaho 510.4 410.9 118.9 42.8 33.8 59.1 47.4 22.1 16.7 142.7 39.2 8.9
Illinois 546.2 439.8 127.7 55.2 40.3 82.8 59.9 23.5 16.5 138.9 38.6 9.7
Indiana 513.0 425.1 119.0 51.0 40.2 93.2 61.9 23.5 16.5 108.9 36.4 8.9
Iowa 545.6 439.4 123.0 54.2 41.1 81.7 53.6 27.4 18.6 126.2 40.4 8.8
Kansas 541.9 427.3 123.2 50.5 37.8 75.5 53.4 23.4 16.7 143.1 39.1 9.1
Kentucky 598.2 466.6 121.3 60.5 44.1 120.4 80.7 25.4 17.3 122.6 40.8 9.8
Louisiana 595.5 417.9 121.9 59.6 42.7 95.2 56.0 24.6 16.7 161.1 33.7 8.1
Maine 546.3 452.8 124.4 46.5 36.7 85.8 66.9 24.6 17.7 120.2 47.8 12.5
Maryland 512.0 419.5 129.9 44.3 34.6 70.0 53.9 21.0 14.9 141.1 34.5 9.1
Massachusetts 539.2 458.6 136.5 45.7 36.0 75.4 62.9 24.0 16.4 135.6 42.2 11.8
Michigan 544.8 428.6 121.4 46.8 35.9 81.4 59.9 24.5 17.1 147.3 40.3 10.4
Minnesota
Mississippi 577.5 406.0 116.8 59.4 43.4 106.4 56.9 21.4 14.6 149.7 30.9 7.5
Missouri 511.4 427.0 124.7 51.7 38.7 92.1 64.4 22.2 15.6 113.6 33.5 8.6
Montana 508.4 424.5 124.2 46.6 36.3 66.0 52.8 22.3 15.9 133.5 37.8 10.4
Nebraska 501.8 417.2 122.7 52.0 41.1 70.7 50.0 23.4 17.7 125.7 34.8 8.2
Nevada 502.2 401.8 114.0 50.5 36.3 71.4 60.3 20.3 14.8 136.0 38.8 10.7
New Hampshire 558.1 458.4 135.1 43.1 36.3 75.7 63.8 25.8 17.8 140.7 50.2 12.9
New Jersey 564.7 450.5 130.2 51.0 39.4 69.3 53.7 25.4 17.9 157.3 42.1 11.3
New Mexico 431.2 367.2 112.1 41.2 31.3 49.7 37.4 18.0 13.8 110.4 26.1 6.0
New York 568.6 451.2 128.6 49.6 38.1 73.9 55.3 26.4 18.1 153.7 41.8 10.6
North Carolina 546.6 417.9 127.1 46.3 34.3 92.3 56.1 22.2 15.2 138.7 36.7 8.9
North Dakota 517.1 411.5 122.2 54.7 40.5 68.3 45.4 22.8 18.5 141.4 37.3 8.5
Ohio 522.1 421.7 120.5 50.3 37.3 87.5 59.8 22.8 15.6 127.1 38.5 9.4
Oklahoma 520.1 411.8 119.2 50.3 38.8 90.1 60.2 21.9 15.4 128.8 33.6 8.1
Oregon 489.5 427.9 128.4 43.3 34.0 66.9 56.6 22.5 15.6 122.8 37.4 9.5
Pennsylvania 559.2 458.3 128.1 52.6 39.7 81.3 56.8 26.1 17.9 133.6 44.2 10.9
Rhode Island 544.3 456.4 129.9 44.8 36.2 79.9 64.0 24.1 17.7 130.6 46.8 13.7
South Carolina 538.7 408.6 125.3 46.8 35.9 90.6 54.0 20.0 13.5 138.1 33.1 8.6
South Dakota 495.0 416.7 125.9 53.2 40.0 68.6 49.2 23.7 16.7 129.3 34.4 9.3
Tennessee 552.7 420.1 120.6 50.3 37.7 98.9 61.7 22.2 15.8 135.5 35.5 8.1
Texas 488.5 384.4 113.1 48.4 33.5 73.0 46.7 21.8 15.4 115.7 28.2 6.6
Utah 480.6 368.0 113.8 36.7 29.4 34.7 23.7 23.9 15.4 156.8 30.7 5.8
Vermont 514.7 439.8 128.0 43.4 34.7 75.4 62.5 24.7 17.2 121.6 39.9 11.0
Virginia 485.4 397.6 124.6 43.0 34.3 77.9 53.0 20.9 14.3 126.3 32.0 8.3
Washington 524.1 444.3 135.0 43.0 35.0 69.2 55.9 25.6 17.3 133.9 37.9 9.5
West Virginia 541.2 436.7 111.2 55.3 41.3 102.8 67.4 22.3 16.2 114.1 39.5 10.9
Wisconsin 524.4 430.7 125.6 46.1 35.7 71.8 54.4 24.9 17.5 129.6 40.1 9.8
Wyoming 472.4 387.6 111.2 44.8 33.3 55.7 45.8 18.8 13.8 127.1 37.1 11.8
United States 522.6 419.0 123.1 48.3 36.6 76.7 54.1 23.1 16.0 131.5 36.4 9.0
*Per 100,000, age adjusted to the 2000 US standard population. This states data are not included in US combined rates because they were unavailable or did not meet
high-quality standards for one or more years during 2008-2012 according to the North American Association of Central Cancer Registries (NAACCR). Rates are based on
incidence data for 2008-2009. Incidence data not submitted to NAACCR. Rates are based on incidence data for 2008-2010.
Source: NAACCR, 2015. Data are collected by cancer registries participating in the National Cancer Institutes SEER program and the Centers for Disease Control and
Preventions National Program of Cancer Registries.
American Cancer Society, Inc., Surveillance Research, 2016

Table 5. Death Rates* for Selected Cancers by State, US, 2008-2012
Non-Hodgkin
All sites Breast Colon & rectum Lung & bronchus lymphoma Pancreas Prostate
State Male Female Female Male Female Male Female Male Female Male Female Male
Alabama 246.8 152.4 22.6 21.2 14.1 82.6 40.1 7.9 5.1 13.3 9.9 26.4
Alaska 211.4 151.5 21.0 18.0 13.7 61.2 44.8 7.8 5.0 13.7 9.2 21.9
Arizona 180.0 128.1 19.7 15.9 11.3 46.6 31.9 7.2 4.6 11.5 8.9 19.4
Arkansas 246.5 156.6 22.3 22.7 15.3 88.0 44.2 8.2 5.5 13.2 9.4 22.7
California 183.4 135.3 21.2 16.8 12.2 43.7 30.5 7.4 4.6 11.8 9.3 21.1
Colorado 173.8 129.4 19.7 15.3 11.8 40.8 29.7 7.0 4.3 10.8 9.0 22.6
Connecticut 192.2 138.4 20.3 14.8 11.0 49.7 35.8 7.1 4.5 13.2 10.2 20.2
Delaware 218.1 156.3 22.1 17.5 12.2 66.4 45.2 6.9 4.8 13.6 9.5 22.6
Dist. of Columbia 227.1 161.6 29.0 18.7 16.6 54.6 33.9 7.1 3.7 15.7 12.2 34.9
Florida 197.1 136.9 21.0 17.2 12.1 58.1 37.3 7.5 4.5 12.1 9.0 18.7
Georgia 218.2 143.5 22.9 19.5 13.1 68.0 37.2 7.3 4.2 12.2 9.0 24.6
Hawaii 171.7 114.8 15.1 16.8 10.7 44.4 25.0 7.4 4.5 12.9 10.2 14.8
Idaho 189.3 134.9 20.7 16.0 11.8 45.9 33.6 8.0 4.9 12.3 8.9 24.7
Illinois 215.9 154.4 23.0 20.3 14.0 62.4 40.7 8.2 5.0 13.0 10.0 22.4
Indiana 232.4 157.8 22.7 20.3 14.0 75.3 44.7 8.6 5.3 12.8 9.5 22.0
Iowa 209.1 145.3 20.7 19.8 14.3 61.4 37.5 8.8 5.2 12.4 9.2 20.7
Kansas 206.1 144.7 21.3 18.7 12.8 61.7 39.1 8.7 4.8 12.7 9.7 19.2
Kentucky 253.6 170.0 22.6 21.8 15.2 92.2 55.2 8.8 5.7 12.8 9.4 21.5
Louisiana 247.4 161.0 25.0 22.7 15.1 77.4 42.8 8.6 5.0 14.9 11.4 24.2
Maine 223.8 154.6 19.4 18.4 12.8 66.5 44.1 8.8 5.3 12.0 10.6 21.1
Maryland 207.4 148.0 23.7 18.9 12.8 57.1 38.6 7.3 4.3 13.4 10.2 22.5
Massachusetts 205.5 147.1 20.3 17.1 12.2 56.2 40.3 7.4 4.5 12.6 10.2 20.5
Michigan 215.9 155.0 23.1 18.6 13.2 64.7 42.8 9.2 5.4 13.4 10.1 20.3
Minnesota 197.0 141.1 20.0 16.5 11.8 49.7 35.6 9.4 5.4 12.0 9.0 22.5
Mississippi 260.4 158.5 24.5 23.9 16.5 88.5 41.4 7.8 4.4 14.4 10.6 28.4
Missouri 222.7 156.8 23.4 20.5 13.9 72.8 45.2 7.8 5.0 12.7 9.8 19.9
Montana 188.5 138.6 20.3 16.1 12.5 49.7 37.2 8.0 4.3 11.2 8.2 23.4
Nebraska 200.9 140.8 19.8 19.8 14.6 55.5 35.5 7.9 5.0 12.0 9.4 22.0
Nevada 201.9 149.0 23.3 21.0 13.8 55.9 44.1 6.8 4.3 12.5 9.2 21.5
New Hampshire 208.3 147.6 20.4 16.2 13.0 57.7 42.1 7.2 4.3 13.6 9.4 20.8
New Jersey 199.0 147.4 23.9 19.6 13.8 52.0 35.3 7.4 4.7 13.3 10.3 20.3
New Mexico 181.0 128.1 20.4 18.0 12.2 40.9 27.2 6.0 4.3 11.1 8.0 21.9
New York 193.8 141.7 21.5 17.9 13.0 51.9 35.1 7.6 4.7 13.0 10.0 20.6
North Carolina 222.2 145.0 22.2 18.0 12.3 72.0 39.1 7.5 4.7 11.9 9.2 23.5
North Dakota 198.1 130.2 19.8 19.6 13.1 53.3 31.8 6.3 4.6 13.3 7.8 22.6
Ohio 228.2 158.5 23.8 20.9 14.1 70.9 43.8 9.0 5.3 13.4 10.1 22.0
Oklahoma 233.6 159.6 23.2 21.7 14.4 75.7 45.3 8.9 5.3 12.4 9.6 22.4
Oregon 203.6 149.8 20.9 17.3 12.8 55.2 41.2 8.3 5.0 12.3 9.7 23.2
Pennsylvania 218.5 153.3 23.2 20.2 14.1 62.4 38.7 8.7 5.2 13.3 10.1 21.1
Rhode Island 216.1 143.3 19.8 17.6 13.1 62.5 41.6 7.7 4.2 12.7 8.4 20.8
South Carolina 232.7 148.8 23.2 19.6 13.4 72.7 38.9 7.6 4.5 13.0 10.1 25.5
South Dakota 196.9 142.8 20.7 18.5 13.2 58.2 35.0 7.5 5.0 10.8 9.6 20.8
Tennessee 245.9 156.7 22.6 21.3 14.8 83.6 45.1 8.7 5.0 12.9 9.6 22.6
Texas 201.8 137.7 21.0 18.9 12.5 56.4 33.7 7.7 4.6 11.8 8.9 19.6
Utah 153.0 108.6 20.8 13.2 10.2 26.4 15.6 7.2 4.6 10.9 8.1 23.3
Vermont 206.2 149.9 18.7 16.2 13.3 57.2 43.8 8.2 4.6 13.4 10.2 22.4
Virginia 211.5 145.8 22.8 17.9 12.9 62.5 38.2 7.9 4.6 12.5 9.5 22.7
Washington 201.8 146.4 20.3 16.4 12.2 53.9 39.7 8.3 5.1 12.7 10.2 22.2
West Virginia 242.5 165.2 22.5 22.9 15.0 80.5 49.3 8.4 5.8 12.0 8.6 20.1
Wisconsin 208.9 146.8 21.0 17.4 12.3 56.3 38.1 8.6 5.2 13.1 10.1 23.1
Wyoming 187.0 140.3 19.5 18.3 12.2 46.5 33.7 6.3 4.8 10.9 8.3 20.3
United States 207.9 145.4 21.9 18.6 13.1 59.8 37.8 7.9 4.8 12.6 9.6 21.4
*Per 100,000, age adjusted to the 2000 US standard population.
Source: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention.

What Are the Costs of Cancer? Census Bureau, 33 million Americans (10%) were uninsured
during the entire 2014 calendar year. This is almost 9 million
The Agency for Healthcare Research and Quality estimates that
fewer than during 2013 because of the implementation in Janu-
the direct medical costs (total of all health care expenditures)
ary 2014 of several new provisions of the Affordable Care Act.
for cancer in the US in 2013 were $74.8 billion. Forty-four percent
The largest increase in health insurance coverage was among
of those costs were for hospital outpatient or office-based pro-
those with the lowest education and income. Hispanics and
vider visits, and 40% were for inpatient hospital stays. These
blacks continue to be the most likely to be uninsured, 20% and
estimates are based on a set of large-scale surveys of individuals
12%, respectively, compared to 8% of non-Hispanic whites. The
and their medical providers called the Medical Expenditure
percentage of uninsured ranged from 3% in Massachusetts to
Panel Survey (MEPS), the most complete, nationally representa-
19% in Texas. Uninsured patients and those from many ethnic
tive data on health care use and expenditures. Visit meps.ahrq.
minority groups are substantially more likely to be diagnosed
gov/mepsweb/ for more information.
with cancer at a later stage, when treatment is often more exten-
Lack of health insurance and other barriers prevent many Amer- sive, more costly, and less successful. To learn more about how
icans from receiving optimal health care. According to the US the Affordable Care Act supports the fight against cancer, see
Advocacy on page 62.
Selected Cancers
This section provides basic information on risk factors, symp- Less common symptoms include other persistent changes to the
toms, early detection, and treatment, as well as statistics on breast, such as thickening, swelling, distortion, tenderness, skin
incidence, mortality, and survival, for the most commonly diag- irritation, redness, scaliness, nipple abnormalities, or spontane-
nosed cancers. The information primarily applies to the more ous discharge. Breast pain is more likely to be caused by benign
common subtypes for each site and may have limited relevance conditions and is not a common symptom of breast cancer.
to rare subtypes.
Risk factors: Potentially modifiable factors associated with
increased breast cancer risk include weight gain after the age of
Breast 18 and/or being overweight or obese (for postmenopausal breast
New cases: In 2016, invasive breast cancer will be diagnosed in cancer), use of menopausal hormone therapy (combined estro-
about 246,660 women and 2,600 men. An additional 61,000 new gen and progestin), physical inactivity, and alcohol consumption.
cases of in situ breast cancer will be diagnosed in women. Breast In addition, recent research indicates that long-term, heavy
cancer is the most frequently diagnosed cancer in women (Fig- smoking may also increase breast cancer risk, particularly
ure 3, page 10). among women who start smoking before their first pregnancy.
The International Agency for Research on Cancer has concluded
Incidence trends: From 2003 to 2012, the most recent 10 years that shift work, particularly at night (i.e., that disrupts sleep pat-
for which data are available, breast cancer incidence rates were terns), may be associated with an increased risk of breast cancer.
stable in white women and increased slightly (by 0.3% per year)
in black women, resulting in the convergence of rates in blacks Non-modifiable factors associated with increased breast cancer
with those in whites. risk include older age; a personal or family history of breast or
ovarian cancer; inherited mutations (genetic alterations) in
Deaths: An estimated 40,890 breast cancer deaths (40,450 women, BRCA1, BRCA2, or other breast cancer susceptibility genes; cer-
440 men) are expected in 2016. Breast cancer ranks second as a tain benign breast conditions (such as atypical hyperplasia); a
cause of cancer death in women. history of ductal or lobular carcinoma in situ; high-dose radia-
Mortality trends: From 2003 to 2012, breast cancer death rates tion to the chest at a young age (e.g., for cancer treatment); high
decreased by 1.9% per year in white women and by 1.4% per year breast tissue density (the amount of glandular tissue relative to
in black women. Overall, breast cancer death rates declined by fatty tissue measured on a mammogram); high bone mineral
36% from 1989 to 2012 due to improvements in early detection density (evaluated during screening for osteoporosis); and type
and treatment, translating to the avoidance of approximately 2 diabetes (independent of obesity). Reproductive factors that
249,000 breast cancer deaths. increase risk include a long menstrual history (menstrual peri-
ods that start early and/or end later in life), recent use of oral
Signs and symptoms: The most common symptom of breast contraceptives, never having children, having ones first child
cancer is a lump or mass in the breast, which is often painless. after age 30, and high natural levels of sex hormones.

Figure 3. Leading Sites of New Cancer Cases and Deaths 2016 Estimates

Male Female Male Female
Prostate Breast Lung & bronchus Lung & bronchus
180,890 (21%) 246,660 (29%) 85,920 (27%) 72,160 (26%)
Lung & bronchus Lung & bronchus Prostate Breast
117,920 (14%) 106,470 (13%) 26,120 (8%) 40,450 (14%)
Colon & rectum Colon & rectum Colon & rectum Colon & rectum
70,820 (8%) 63,670 (8%) 26,020 (8%) 23,170 (8%)
Urinary bladder Uterine corpus Pancreas Pancreas
58,950 (7%) 60,050 (7%) 21,450 (7%) 20,330 (7%)
Melanoma of the skin Thyroid Liver & intrahepatic bile duct Ovary
46,870 (6%) 49,350 (6%) 18,280 (6%) 14,240 (5%)
Non-Hodgkin lymphoma Non-Hodgkin lymphoma Leukemia Uterine corpus
40,170 (5%) 32,410 (4%) 14,130 (4%) 10,470 (4%)
Kidney & renal pelvis Melanoma of the skin Esophagus Leukemia
39,650 (5%) 29,510 (3%) 12,720 (4%) 10,270 (4%)
Oral cavity & pharynx Leukemia Urinary bladder Liver & intrahepatic bile duct
34,780 (4%) 26,050 (3%) 11,820 (4%) 8,890 (3%)
Leukemia Pancreas Non-Hodgkin lymphoma Non-Hodgkin lymphoma
34,090 (4%) 25,400 (3%) 11,520 (4%) 8,630 (3%)
Liver & intrahepatic bile duct Kidney & renal pelvis Brain & other nervous system Brain & other nervous system
28,410 (3%) 23,050 (3%) 9,440 (3%) 6,610 (2%)
All sites All sites All sites All sites
841,390 (100%) 843,820 (100%) 314,290 (100%) 281,400 (100%)
Estimates are rounded to the nearest 10, and cases exclude basal cell and squamous cell skin cancers and in situ carcinoma except urinary bladder.
Factors associated with a decreased risk include breastfeeding at age 30. For more information on breast cancer screening, see
for at least one year, regular moderate or vigorous physical activ- the American Cancer Societys screening guidelines on page 66.
ity, and maintaining a healthy body weight. Two medications
Treatment: Taking into account tumor characteristics, includ-
tamoxifen and raloxifene have been approved to reduce breast
ing size and extent of spread, as well as patient preference,
cancer risk in women at high risk. Raloxifene appears to have a
treatment usually involves either breast-conserving surgery
lower risk of certain side effects, but is only approved for use in
(surgical removal of the tumor and surrounding tissue) or mas-
postmenopausal women.
tectomy (surgical removal of the breast). For early breast cancer
Early detection: Mammography is a low-dose x-ray procedure (without spread to the skin, chest wall, or distant organs),
used to detect breast cancer at an early stage. Numerous studies long-term survival is similar for women treated with breast-
have shown that early detection with mammography helps save conserving surgery plus radiation therapy and those treated
lives and increases treatment options. However, like any screen- with mastectomy. Underarm lymph nodes are usually removed
ing tool, mammography is not perfect. For example, it can miss and evaluated during surgery to determine whether the tumor
cancers, particularly those in women with very dense breasts, has spread beyond the breast. Women undergoing mastectomy
and also detects cancers that would never have caused harm, who elect breast reconstruction have several options, including
resulting in some overdiagnoses. Most (95%) of the 10% of women the tissue or materials used to restore breast shape and the tim-
who have an abnormal mammogram do not have cancer. For ing of the procedure.
women at average risk of breast cancer, recently updated Ameri-
Treatment may also involve radiation therapy, chemotherapy
can Cancer Society screening guidelines recommend that those
(before or after surgery), hormonal therapy, and/or targeted
40 to 44 years of age have the choice for annual mammography;
therapy. Women with early stage breast cancer that tests posi-
those 45 to 54 have annual mammography; and those 55 years of
tive for hormone receptors benefit from treatment with
age and older have biennial or annual mammography, continu-
hormonal therapy for at least 5 years. For women whose cancer
ing as long as their overall health is good and life expectancy is
overexpresses the growth-promoting protein HER2, several tar-
10 or more years. For some women at high risk of breast cancer,
geted therapies are available.
annual screening using magnetic resonance imaging (MRI) in
addition to mammography is recommended, typically starting

Survival: The 5-, 10-, and 15-year relative survival rates for Neuroblastoma (6%), a cancer of the nervous system that is
breast cancer are 89%, 83%, and 78%, respectively. (Caution most common in children younger than 5 years of age and
should be used when interpreting long-term survival rates usually appears as a swelling in the abdomen
because they represent patients who were diagnosed many years Wilms tumor (5%), a kidney cancer (also called nephroblastoma)
ago and do not reflect recent advances in detection and treat- that may be recognized by a swelling or lump in the abdomen
ment.) Most cases (61%) are diagnosed at a localized stage (no
Non-Hodgkin lymphoma including Burkitt lymphoma (5%),
spread to lymph nodes, nearby structures, or other locations
and Hodgkin lymphoma (3%), which are most common dur-
outside the breast), for which the 5-year survival is 99% (Table 8,
ing adolescence, affect lymph nodes, but may also involve the
page 21). Survival rates have increased over time for both
bone marrow and other organs; may cause swelling of lymph
white and black women, although they remain 11 percentage
nodes in the neck, armpit, or groin, as well as general weak-
points lower, in absolute terms, for blacks (Table 7, page 18).
ness and fever
See Breast Cancer Facts & Figures 2015-2016 at cancer.org/statistics Rhabdomyosarcoma (3%), a soft tissue sarcoma that can
for more detailed information. occur in the head and neck, genitourinary area, trunk, and
extremities, and may cause pain and/or a mass or swelling
Childhood Cancer (Ages 0-14 years) Osteosarcoma (2%), a bone cancer that most often occurs in
New cases: An estimated 10,380 new cases are expected to adolescents and commonly appears as sporadic pain in the
occur among children 0 to 14 years of age in 2016. affected bone that may worsen at night or with activity and
eventually progresses to local swelling
Incidence trends: Childhood cancer incidence rates have slowly
Retinoblastoma (2%), an eye cancer that usually occurs in
increased by 0.6% per year since 1975, when population-based
children younger than 5 years of age and is typically recog-
cancer registration began in the US.
nized because the pupil appears white or pink instead of
Deaths: An estimated 1,250 cancer deaths are expected to occur the normal red color in flash photographs or during an eye
among children in 2016. Cancer is the second leading cause of examination
death in children ages 1-14 years, exceeded only by accidents. Ewing sarcoma (1%), another type of cancer that usually
Mortality trends: Childhood cancer death rates declined by a arises in the bone, is most common in adolescents, and typi-
total of 66% from 1969 (6.5 per 100,000) to 2012 (2.2 per 100,000), cally appears as pain at the tumor site
largely due to improvements in treatment and high rates of par- Risk factors: There are few known risk factors for childhood
ticipation in clinical trials. From 2003 to 2012, the death rate cancer. Exposure to ionizing radiation increases the risk of
declined by 1.3% per year. childhood leukemia and possibly other cancers. A small per-
Signs and symptoms: The early diagnosis of childhood cancer centage of childhood cancers are caused by a genetic mutation
is often hampered by nonspecific symptoms that are similar that is inherited or arises during fetal development. Children
to those of more common childhood diseases. Parents should with certain genetic syndromes, such as Down syndrome, are at
ensure that children have regular medical checkups and be alert increased risk for leukemia.
to unusual, persistent symptoms. These include an unusual mass Treatment: Childhood cancers are treated with surgery, radia-
or swelling; unexplained paleness or loss of energy; a sudden tion, and/or chemotherapy/targeted therapy based on the type
increase in the tendency to bruise or bleed; a persistent, local- and stage of cancer. Treatment is coordinated by a team of
ized pain or limping; a prolonged, unexplained fever or illness; experts, including pediatric oncologists and nurses, social work-
frequent headaches, often with vomiting; sudden eye or vision ers, psychologists, and others trained to assist children and their
changes; and excessive, rapid weight loss. Major categories of families. Outcomes are most successful when treatment is man-
pediatric cancer, based on the International Classification of aged by specialists at a childrens cancer center. If the child is
Childhood Cancer, their distribution (including benign brain eligible, placement in a clinical trial, which compares a new
tumors), and more specific symptoms include: treatment to the best current treatment, should be considered.
Leukemia (30% of all childhood cancers), which may be
Survival: Survival for all invasive childhood cancers combined
recognized by bone and joint pain, weakness, pale skin,
has improved markedly over the past 30 years due to new and
bleeding or bruising easily, and fever or infection
improved treatments. The 5-year relative survival rate increased
Brain and other central nervous system tumors (26%), from 58% in the mid-1970s to 83% in the most recent time period
which may cause headaches, nausea, vomiting, blurred or (2005-2011). However, rates vary considerably depending on can-
double vision, seizures, dizziness, and difficulty walking or cer type, patient age, and other characteristics. The 5-year
handling objects survival for retinoblastoma is 97%; Hodgkin lymphoma, 98%;
Wilms tumor, 92%; non-Hodgkin lymphoma, 89%; leukemia,

85% (89% for acute lymphoid leukemia and 65% for acute myeloid Signs and symptoms: Early stage colorectal cancer typically
leukemia); neuroblastoma, 78%; Ewing sarcoma, 78%; brain and does not have symptoms, which is why screening is usually nec-
other central nervous system tumors (excluding benign brain essary to detect this cancer early. Symptoms may include rectal
tumors), 72%; osteosarcoma, 69%; and rhabdomyosarcoma, bleeding, blood in the stool, a change in bowel habits or stool
69%. Pediatric cancer patients may experience treatment- shape (e.g., narrower than usual), the feeling that the bowel is
related side effects long after active treatment, including not completely empty, cramping pain in the lower abdomen,
impairment in the function of specific organs (e.g., cognitive decreased appetite, or weight loss. In some cases, blood loss
defects) and secondary cancers. The Childrens Oncology Group from the cancer leads to anemia (low number of red blood cells),
(COG) has developed guidelines for screening and management causing symptoms such as weakness and fatigue. Timely evalu-
of late effects in survivors of childhood cancer. See the COG ation of symptoms consistent with colorectal cancer is essential,
website at survivorshipguidelines.org for more information. The even for adults younger than age 50.
Childhood Cancer Survivor Study, which has followed more
Risk factors: The risk of colorectal cancer increases with age.
than 14,000 long-term childhood cancer survivors, has also pro-
Modifiable factors that increase risk include obesity, physical
vided valuable information about the late effects of cancer
inactivity, long-term smoking, high consumption of red or pro-
treatment; visit ccss.stjude.org for more information.
cessed meat, low calcium intake, moderate to heavy alcohol
See the Cancer Facts & Figures 2014 Special Section: Childhood consumption, and very low intake of fruit and vegetables. Con-
& Adolescent Cancers at cancer.org/statistics for more detailed sumption of whole-grain fiber reduces risk. Hereditary and
information. medical factors that increase risk include a personal or family
history of colorectal cancer and/or polyps, certain inherited
genetic conditions (e.g., Lynch syndrome, also known as heredi-
Colon and Rectum tary nonpolyposis colorectal cancer [HNPCC], and familial
New cases: An estimated 95,270 cases of colon cancer and adenomatous polyposis [FAP]), a personal history of chronic
39,220 cases of rectal cancer are expected to be diagnosed in inflammatory bowel disease (e.g., ulcerative colitis or Crohn dis-
2016. Colorectal cancer is the third most common cancer in both ease), and type 2 diabetes.
men and women.
Regular long-term use of nonsteroidal anti-inflammatory drugs,
Incidence trends: Incidence rates have generally been decreas- such as aspirin, reduces risk. However, these drugs can have
ing since the mid-1980s due to both changes in risk factors (e.g., serious adverse health effects, such as stomach bleeding. While
decreased smoking, increased use of nonsteroidal anti-inflam- the American Cancer Society has not made recommendations
matory drugs) and the uptake of screening among adults 50 about their use, the US Preventive Services Task Force issued a
years of age and older. The pace of the decline has increased over draft statement in September 2015 recommending daily, low-
the past 5 data years. However, trends differ by age. From 2008 to dose aspirin for some individuals at high risk for cardiovascular
2012, incidence rates declined by 4.5% per year among adults 50 disease based on a review of aspirins harms and benefits, includ-
years of age and older, but increased by 1.8% per year among ing the benefit of colorectal cancer prevention.
those younger than age 50. Reasons for the increase in young
adults, which has been consistent since at least 1992, are Early detection: Beginning at the age of 50, men and women
unknown. who are at average risk for developing colorectal cancer should
begin screening. Some screening tests can detect colorectal pol-
Deaths: An estimated 49,190 deaths from colorectal cancer are yps, which can be removed before becoming cancerous, whereas
expected to occur in 2016. Colorectal cancer is the third leading all tests can detect cancer at an early stage, when treatment is
cause of cancer death in both men and women and the second usually less extensive and more successful. There are a number
leading cause of cancer death when men and women are com- of recommended screening options, which differ in terms of how
bined. Deaths for cancers of the colon and rectum are combined often they should be performed and whether bowel preparation
because of the large number of rectal cancer deaths that are mis- is required, as well as benefits, limitations, potential harms, and
classified as colon on death certificates. This is thought to be cost. For the Societys recommendations for colorectal cancer
largely due to the widespread use of the term colon cancer to screening, see page 66.
refer to both colon and rectal cancers in educational messaging.
Treatment: Surgery is the most common treatment for colorec-
Mortality trends: Colorectal cancer death rates have been tal cancers that have not spread. A permanent colostomy
declining since 1980 in men and since 1947 in women, with an (creation of an abdominal opening for elimination of body
overall drop of 49% from 1976 to 2012. This trend reflects waste) is not usually required for rectal cancer and is rarely nec-
improvements in early detection and treatment, as well as essary for colon cancer. Chemotherapy alone, or in combination
declines in incidence. From 2003 to 2012, death rates declined by with radiation, is given before (neoadjuvant) or after (adjuvant)
2.8% per year.

surgery to most patients whose cancer has penetrated the bowel (observation) may be an option for some patients with small
wall deeply or spread to lymph nodes. For colorectal cancer that tumors. Patients who are not surgical candidates may be offered
has spread to other parts of the body (metastatic colorectal can- ablation therapy, a procedure that uses heat or cold to destroy
cer), treatments typically include chemotherapy and/or targeted the tumor. So far, adjuvant treatment has not been shown to be
therapy. helpful after surgery, although several targeted therapies are
being studied. For metastatic disease, targeted therapies are
Survival: The 5- and 10-year relative survival rates for colorec-
typically the main treatment, sometimes along with removal of
tal cancer are 65% and 58%, respectively. Although 5-year
the kidney.
survival for localized disease is 90% (Table 8, page 21), only
39% of patients are diagnosed at this stage, in part due to the Survival: The 5- and 10-year relative survival rates for kidney
underuse of screening. and renal pelvis cancer are 73% and 63%, respectively. Almost
two-thirds of cases (65%) are diagnosed at a local stage, for
For more detailed information, see Colorectal Cancer Facts &
which the 5-year relative survival rate is 92% (Table 8, page
Figures 2014-2016 at cancer.org/statistics.
21). Five-year survival for cancer in the renal pelvis (50%) is
lower than for cancer in the kidney (74%).
Kidney & Renal Pelvis
New cases: An estimated 62,700 new cases of kidney (renal) can- Leukemia
cer are expected to be diagnosed in 2016. These are primarily
New cases: An estimated 60,140 new cases of leukemia are
renal cell carcinomas, which occur in the body of the kidney, but
expected in 2016. Leukemia is a cancer of the bone marrow and
also include cancers of the renal pelvis (6%), which behave more
blood and is classified into four main groups according to cell
like bladder cancer, and Wilms tumor (1%), a childhood cancer
type and rate of growth: acute lymphocytic (ALL), chronic lym-
that usually develops before the age of 5 (see Childhood Cancer
phocytic (CLL), acute myeloid (AML), and chronic myeloid
(Ages 0-14 years) on page 11). Men are twice as likely as
(CML). Although leukemia is often thought of as a childhood
women to be diagnosed with kidney cancer.
cancer, the majority (91%) of cases are diagnosed in adults 20
Incidence trends: Kidney cancer incidence rates increased over years of age and older. Among adults, the most common types
the past several decades, in part due to incidental diagnoses are CLL (37%) and AML (31%), while ALL is most common in
during abdominal imaging. However, rates stabilized from 2008 those 0 to 19 years, accounting for 75% of cases.
to 2012.
Incidence trends: Overall leukemia incidence has increased
Deaths: An estimated 14,240 deaths from kidney cancer are slowly for many decades; from 2003 to 2012, rates increased by
expected to occur in 2016. 1.3% per year.
Mortality trends: Kidney cancer death rates have been decreas- Deaths: An estimated 24,400 deaths are expected to occur in 2016.
ing by 0.7% per year since 1995.
Mortality trends: In contrast to incidence, death rates for leu-
Signs and symptoms: Early stage kidney cancer usually has no kemia have dropped 18% since 1980, with a steady decline of
symptoms. As the tumor progresses, symptoms may include 1.0% per year from 2001 to 2012.
blood in the urine, a pain or lump in the lower back or abdomen,
Signs and symptoms: Symptoms may include fatigue, paleness,
fatigue, weight loss, fever, or swelling in the legs and ankles.
weight loss, repeated infections, fever, bleeding or bruising eas-
Risk factors: Obesity and tobacco smoking increase risk for kid- ily, bone or joint pain, and swelling in the lymph nodes or
ney cancer. Additional risk factors include high blood pressure; abdomen. In acute leukemia, these signs can appear suddenly.
chronic renal failure; and occupational exposure to certain Chronic leukemia typically progresses slowly with few symp-
chemicals, such as trichloroethylene. Radiation exposure (e.g., toms and is often diagnosed during routine blood tests.
for cancer treatment) slightly increases risk. A small proportion
Risk factors: Exposure to ionizing radiation increases the risk
of renal cell cancers are the result of rare hereditary conditions
of most types of leukemia (excluding CLL). Medical radiation,
(e.g., von Hippel-Lindau disease and hereditary papillary renal
such as that used in cancer treatment, is one of the most com-
cell carcinoma).
mon sources of radiation exposure. The risk of leukemia is also
Early detection: There are no recommended screening tests for increased in patients treated with chemotherapy, children with
the early detection of kidney cancer among people at average risk. Down syndrome and certain other genetic abnormalities, and
workers in the rubber-manufacturing industry. Studies suggest
Treatment: Surgery (traditional or laparoscopic, i.e., minimally
that obesity also increases risk.
invasive, performed through very small incisions) is the primary
treatment for most kidney cancers, although active surveillance

Table 6. Probability (%) of Developing Invasive Cancer during Selected Age Intervals by Sex, US, 2010-2012*
Birth to 49 50 to 59 60 to 69 70 and older Birth to death
All sites Male 3.4 (1 in 29) 6.5 (1 in 15) 14.5 (1 in 7) 34.6 (1 in 3) 42.1 (1 in 2)
Female 5.4 (1 in 19) 6.0 (1 in 17) 10.0 (1 in 10) 26.1 (1 in 4) 37.6 (1 in 3)
Breast Female 1.9 (1 in 53) 2.3 (1 in 44) 3.5 (1 in 29) 6.7 (1 in 15) 12.3 (1 in 8)
Colon & rectum Male 0.3 (1 in 300) 0.7 (1 in 149) 1.2 (1 in 82) 3.7 (1 in 27) 4.7 (1 in 21)
Kidney & renal pelvis Male 0.2 (1 in 467) 0.3 (1 in 295) 0.6 (1 in 158) 1.3 (1 in 76) 2.0 (1 in 49)
Leukemia Male 0.2 (1 in 415) 0.2 (1 in 591) 0.4 (1 in 261) 1.4 (1 in 72) 1.8 (1 in 57)
Lung & bronchus Male 0.2 (1 in 608) 0.7 (1 in 145) 2.0 (1 in 51) 6.4 (1 in 16) 7.2 (1 in 14)
Melanoma of the skin Male 0.3 (1 in 297) 0.4 (1 in 238) 0.8 (1 in 127) 2.2 (1 in 45) 3.0 (1 in 33)
Non-Hodgkin lymphoma Male 0.3 (1 in 376) 0.3 (1 in 347) 0.6 (1 in 174) 1.8 (1 in 55) 2.4 (1 in 42)
Thyroid Male 0.2 (1 in 560) 0.1 (1 in 821) 0.2 (1 in 635) 0.2 (1 in 451) 0.6 (1 in 169)
Prostate Male 0.3 (1 in 325) 2.1 (1 in 48) 5.8 (1 in 17) 10.0 (1 in 10) 14.0 (1 in 7)
Uterine cervix Female 0.3 (1 in 364) 0.1 (1 in 850) 0.1 (1 in 871) 0.2 (1 in 576) 0.6 (1 in 157)
Uterine corpus Female 0.3 (1 in 355) 0.6 (1 in 170) 0.9 (1 in 107) 1.3 (1 in 76) 2.8 (1 in 36)
*For those who are free of cancer at the beginning of each age interval. All sites excludes basal cell and squamous cell skin cancers and in situ cancers except urinary
bladder. Statistic is for whites.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.7.3. Statistical Research and Applications Branch, National Cancer Institute, 2015.
srab.cancer.gov/devcan.
Please note: The probability of developing cancer for additional sites, as well as the probability of cancer death, can be found in Supplemental Data at cancer.org/statistics.
Some risk factors are most closely associated with specific types Some of these drugs are also used to treat a type of ALL involv-
of leukemia. For example, family history is a strong risk factor ing a similar genetic defect. People diagnosed with CLL that is
for CLL. Cigarette smoking is a risk factor for AML in adults, and not progressing or causing symptoms may not require treat-
there is accumulating evidence that parental smoking before ment. For those who do require treatment, CLL-targeted drugs
and after childbirth may increase the risk of childhood leuke- are effective for some patients, even when other treatments are
mia. There is limited evidence that maternal exposure to paint no longer working. Certain types of leukemia may be treated
fumes also increases the risk of childhood leukemia. Exposure with high-dose chemotherapy followed by stem cell transplanta-
to certain chemicals, such as formaldehyde and benzene, tion under appropriate conditions.
increases the risk of myeloid leukemia. Infection with human
Survival: Survival rates vary substantially by leukemia subtype,
T-cell leukemia virus type I (HTLV-I) can cause a rare type of
ranging from a current (2005-2011) 5-year relative survival of
leukemia called adult T-cell leukemia/lymphoma. The preva-
26% for patients diagnosed with AML to 82% for those with CLL.
lence of HTLV-I infection is most common in southern Japan and
Advances in treatment have resulted in a dramatic improve-
the Caribbean, and infected individuals in the US tend to be
ment in survival over the past three decades for most types of
immigrants (or their descendants) from these regions.
leukemia (Table 7, page 18). For example, from 1975-1977 to
Early detection: There are no recommended screening tests for 2005-2011, the overall 5-year relative survival for ALL increased
the early detection of leukemia. However, it is sometimes diag- from 41% to 70%. In large part due to the discovery of targeted
nosed early because of abnormal results on blood tests performed drugs, the 5-year survival rate for CML has doubled over the past
for other indications. two decades, from 31% in the early 1990s to 63% for patients
diagnosed from 2005 to 2011. Survival rates beyond 5 years are
Treatment: Chemotherapy is used to treat most types of leuke-
more relevant for chronic than for acute leukemia because of the
mia. Various anticancer drugs are used, either in combination or
slow-growing nature of chronic disease. For example, the abso-
as single agents. Several targeted drugs are effective for treating
lute drop in the survival rate from 5 to 10 years following
CML because they attack cells with the Philadelphia chromo-
diagnosis is 15 percentage points for chronic leukemia versus 3
some, the genetic abnormality that is the hallmark of CML.
points for acute leukemia.

Liver Treatment: Early stage liver cancer can sometimes be treated
successfully with surgery to remove part of the liver (partial
New cases: An estimated 39,230 new cases of liver cancer
hepatectomy); however, only a limited number of patients have
(including intrahepatic bile duct cancers) are expected to occur
sufficient healthy liver tissue for this option. Liver transplanta-
in the US during 2016, approximately three-fourths of which will
tion may be possible for individuals with small tumors who are
be hepatocellular carcinoma (HCC). Liver cancer is about 3
not candidates for partial hepatectomy. Other treatment options
times more common in men than in women.
include ablation (tumor destruction) or embolization (blocking
Incidence trends: Liver cancer incidence has more than tripled blood flow to the tumor).
since 1980. However, rates in young adults have recently begun
Fewer treatment options exist for patients diagnosed at an
to decline. From 2008 to 2012, the rate increased by 3.5% per year
advanced stage. Sorafenib (Nexavar) is a targeted drug approved
among those 50 and older, but decreased by 3.9% per year among
for the treatment of HCC in patients who are not candidates for
adults younger than 50 years of age.
surgery and do not have severe cirrhosis.
Deaths: An estimated 27,170 liver cancer deaths are expected
Survival: The 1- and 5-year relative survival rates for patients
in 2016.
with liver cancer are 44% and 17%, respectively. Forty-three per-
Mortality trends: Liver cancer death rates have generally been cent of patients are diagnosed with a localized stage of disease,
increasing since 1980; from 2003 to 2012, rates increased by 2.7% for which 5-year survival is 31% (Table 8, page 21).
per year.
Signs and symptoms: Common symptoms, which do not usu- Lung and Bronchus
ally appear until the cancer is advanced, include abdominal New cases: Lung cancer is the second most commonly diag-
pain and/or swelling, weight loss, weakness, loss of appetite, nosed cancer in both men and women. An estimated 224,390
jaundice (a yellowish discoloration of the skin and eyes), and new cases of lung cancer are expected in 2016, accounting for
fever. Enlargement of the liver is the most common physical sign. about 14% of all cancer diagnoses.
Risk factors: The most important risk factors for liver cancer in Incidence trends: The incidence rate has been declining since
the US are chronic infection with hepatitis B virus (HBV) and/or the mid-1980s in men, but only since the mid-2000s in women.
hepatitis C virus (HCV), heavy alcohol consumption, obesity, Gender differences reflect historical patterns of smoking uptake
diabetes, tobacco smoking, and certain rare genetic disorders, and cessation over the past several decades. From 2008 to 2012,
such as hemochromatosis. A vaccine that protects against HBV lung cancer incidence rates decreased by 3.0% per year in men
has been available since 1982, and is recommended for all infants and by 1.9% per year in women.
at birth; for all children under 18 years of age who were not vac-
cinated at birth; and for adults in high-risk groups (e.g., health Deaths: Lung cancer accounts for more deaths than any other
care workers, injection drug users, and those younger than 60 cancer in both men and women. An estimated 158,080 deaths
years of age who have been diagnosed with diabetes). There is no are expected to occur in 2016, accounting for about 1 in 4 cancer
vaccine available to prevent HCV infection, although new com- deaths.
bination antiviral therapies can often clear the infection and Mortality trends: Death rates have declined by 38% since 1990
reduce the risk of cancer development among those already in men and by 12% since 2002 in women due to the drop in smok-
infected. The Centers for Disease Control and Prevention (CDC) ing prevalence. From 2008 to 2012, rates decreased by 2.9% per
recommends one-time HCV testing for everyone born from 1945 year in men and by 1.9% per year in women.
to 1965 because people in this birth cohort account for about
three-fourths of HCV-infected individuals and HCV-related Signs and symptoms: Symptoms do not usually occur until the
deaths in the US. Preventive measures for HCV infection include cancer is advanced, and may include persistent cough, sputum
screening of donated blood, organs, and tissues; adherence to streaked with blood, chest pain, voice change, worsening short-
infection control practices during medical and dental proce- ness of breath, and recurrent pneumonia or bronchitis.
dures; and needle-exchange programs for injection drug users. Risk factors: Cigarette smoking is by far the most important
Visit the CDC website at cdc.gov/hepatitis/ for more information risk factor for lung cancer; 80% of lung cancer deaths in the US
on viral hepatitis, including who is at risk. are caused by smoking. Risk increases with both quantity and
Early detection: Although screening for liver cancer has not duration of smoking. Cigar and pipe smoking also increase risk.
been shown to reduce mortality, many health care providers in Exposure to radon gas released from soil and building materials
the US test individuals at high risk for the disease (e.g., those is estimated to be the second-leading cause of lung cancer in the
with cirrhosis) with ultrasound or blood tests. US. Other risk factors include occupational or environmental
exposure to secondhand smoke, asbestos (particularly among

smokers), certain metals (chromium, cadmium, arsenic), some Incidence trends: Incidence rates for Hodgkin lymphoma
organic chemicals, radiation, air pollution, and diesel exhaust. increased slightly from 2001 to 2007, then declined from 2008 to
Additional occupational exposures that increase risk include 2012 by 2.4% per year. Incidence rates for NHL leveled off from
rubber manufacturing, paving, roofing, painting, and chimney 2003 to 2012 after increasing for several decades. (Patterns vary
sweeping. Risk is also probably increased among people with a for subtypes.)
history of tuberculosis. Genetic susceptibility plays a role in the
Deaths: An estimated 21,270 deaths from lymphoma will occur
development of lung cancer, especially in those who develop the
in 2016, most of which will be due to NHL (20,150).
disease at a young age.
Mortality trends: Death rates for Hodgkin lymphoma have
Early detection: Screening with low-dose spiral computed
been decreasing for the past four decades; from 2003 to 2012,
tomography (LDCT) has been shown to reduce lung cancer mor-
rates decreased by 2.5% per year. Death rates for NHL began
tality by 20% compared to standard chest x-ray among adults
decreasing in the late 1990s, with a decline of 2.5% per year from
with at least a 30 pack-year smoking history who were current
2003 to 2012. Reductions in lymphoma death rates reflect
smokers or had quit within 15 years. The American Cancer Soci-
improvements in treatment.
ety guidelines for the early detection of lung cancer endorse a
process of shared decision making between clinicians who have Signs and symptoms: The most common symptoms of lym-
access to high-volume, high-quality lung cancer screening pro- phoma are caused by swollen lymph nodes, and include lumps
grams and current or former smokers (quit within 15 years) who under the skin; chest pain; shortness of breath; and abdominal
are 55 to 74 years of age, in good health, and with at least a 30 fullness and loss of appetite. Other symptoms can include itch-
pack-year history of smoking. Shared decision making should ing, night sweats, fatigue, unexplained weight loss, and
include a discussion of the benefits, uncertainties, and harms intermittent fever.
associated with lung cancer screening. The US Preventive Ser-
Risk factors: Like most cancers, the risk of developing NHL
vices Task Force has issued similar guidelines. For more
increases with age. In contrast, the risk of Hodgkin lymphoma
information on lung cancer screening, see the American Cancer
increases during adolescence and early adulthood, decreases
Societys screening guidelines on page 66.
during middle age, and then increases again later in life. Most of
Treatment: Appropriate treatment for lung cancer is based on the few known risk factors for lymphoma are associated with
whether the tumor is small cell (13%) or non-small cell (83%), as severely altered immune function. For example, risk is elevated
well as other tumor characteristics. Based on type and stage of in people who receive immune suppressants to prevent organ
cancer, as well as specific molecular characteristics of cancer transplant rejection. Certain infectious agents increase the risk
cells, treatments can include surgery, radiation therapy, chemo- of some lymphoma subtypes. Epstein-Barr virus causes Burkitt
therapy, and/or targeted therapies. For early stage non-small cell lymphoma (an aggressive type of NHL), as well as a number of
lung cancers, surgery is usually the treatment of choice; chemo- autoimmune-related NHLs, post-transplant lymphoprolifera-
therapy (sometimes in combination with radiation therapy) may tive disorders (the most common cancer after organ transplant),
be given as well. Advanced-stage non-small cell lung cancer and a subset of Hodgkin lymphoma. In addition, chronic infec-
patients are usually treated with chemotherapy, targeted drugs tion with infectious agents that cause immunosuppression (e.g.,
(or a combination of the two), or immunotherapy. Chemother- human immunodeficiency virus [HIV]) or that cause the
apy, alone or combined with radiation, is the usual treatment for immune system to be continuously active (e.g., Helicobacter
small cell lung cancer; on this regimen, a large percentage of pylori, hepatitis C virus) are associated with certain NHL sub-
patients experience remission, though the cancer often returns. types. A family history of lymphoma confers increased risk of all
Hodgkin lymphoma and NHL subtypes, and a growing number
Survival: The 1- and 5-year relative survival rates for lung can-
of confirmed common genetic variations are associated with
cer are 44% and 17%, respectively. Only 16% of lung cancers are
modestly increased risk. Studies also suggest a role for some
diagnosed at a localized stage, for which the 5-year survival is
behavioral risk factors (e.g., body weight) and environmental
55% (Table 8, page 21). The 5-year survival rate for small cell
exposures for some subtypes.
lung cancer (7%) is lower than that for non-small cell (21%).
Treatment: NHL patients are usually treated with chemotherapy;
radiation, alone or in combination with chemotherapy, is used
Lymphoma less often. Targeted drugs directed at lymphoma cells are used
New cases: An estimated 81,080 new cases of lymphoma will be for some NHL subtypes, as are antibodies linked to a chemother-
diagnosed in 2016. This cancer begins in certain immune system apy drug or a radioactive atom. If NHL persists or recurs after
cells, and is classified as either Hodgkin lymphoma (8,500 cases) standard treatment, stem cell transplantation may be an option.
or non-Hodgkin lymphoma (NHL, 72,580 cases).

Hodgkin lymphoma is usually treated with chemotherapy, radi- by dentists and physicians can often detect premalignant abnor-
ation therapy, or a combination of the two, depending on disease malities and cancer at an early stage, when treatment may be
stage and cell type. Stem cell transplantation may be an option less extensive and more successful.
if other treatments are not effective. Patients whose Hodgkin
Treatment: Radiation therapy and surgery, separately or in
lymphoma has failed to respond to treatment may be given a
combination, are standard treatments; chemotherapy is added
monoclonal antibody linked to a chemotherapy drug.
for advanced disease. Targeted therapy may be combined with
Survival: Survival varies widely by subtype and stage of disease. radiation in initial treatment or used to treat recurrent cancer.
For NHL, the overall 5- and 10-year relative survival rates are
Survival: The 5- and 10-year relative survival rates for people
70% and 60%, respectively. For Hodgkin lymphoma, the 5- and
with cancer of the oral cavity and pharynx are 63% and 52%,
10-year relative survival rates are 86% and 80%, respectively.
respectively. Less than one-third (31%) of cases are diagnosed at
a local stage, for which 5-year survival is 83% (Table 8, page
Oral Cavity and Pharynx 21). Five-year survival varies substantially by subsite, and is
New cases: An estimated 48,330 new cases of cancer of the oral highest for lip (90%) and salivary gland (73%) and lowest for
cavity and pharynx (throat) are expected in 2016. Incidence hypopharynx (32%) and floor of mouth (51%).
rates are more than twice as high in men as in women.
Incidence trends: From 2003 to 2012, incidence rates among Ovary
whites increased by 1.3% per year in men and were stable in New cases: An estimated 22,280 new cases of ovarian cancer are
women, while among blacks rates declined by 2.8% per year in expected in the US in 2016.
men and by 1.6% per year in women. The increase among white
Incidence trends: From 2003 to 2012, ovarian cancer incidence
men is driven by a subset of cancers in the oropharynx, includ-
rates decreased by 0.9% per year, a trend that has held steady
ing the base of tongue and tonsils, that is associated with human
since the mid-1980s.
papillomavirus (HPV) infection. HPV-associated oral cancers
recently began increasing in white women as well. Deaths: An estimated 14,240 deaths are expected in 2016. Ovar-
ian cancer accounts for 5% of cancer deaths among women,
Deaths: An estimated 9,570 deaths from cancers of the oral cav-
causing more deaths than any other gynecologic cancer.
ity and pharynx are expected in 2016.
Mortality trends: The decline in ovarian cancer death rates
Mortality trends: Overall death rates for cancers of the oral
was slow from 1975 until 2002, but gained momentum in the
cavity and pharynx have been decreasing over most of the past
past decade. From 2003 to 2012, the rate decreased by 2.0% per
three decades, partly due to the downturn in the smoking epi-
year.
demic. However, from 2003 to 2012, while rates continued to
decrease in women (by 1.1% per year in whites and 3.5% per year Signs and symptoms: Early ovarian cancer usually has no obvi-
in blacks), they stabilized in men, likely due to the increased ous symptoms. However, studies indicate that some women
incidence of HPV-related cancers. experience persistent, nonspecific symptoms, such as bloating,
pelvic or abdominal pain, difficulty eating or feeling full quickly,
Signs and symptoms: Symptoms may include a lesion in the
or urinary urgency or frequency. Women who experience such
throat or mouth that bleeds easily and does not heal; a persistent
symptoms daily for more than a few weeks should seek prompt
red or white patch, lump, or thickening in the throat or mouth;
medical evaluation. The most common sign of ovarian cancer is
ear pain; a neck mass; or coughing up blood. Difficulty chewing,
swelling of the abdomen, which is caused by the accumulation
swallowing, or moving the tongue or jaws are often late
of fluid. Abnormal vaginal bleeding is rarely a symptom of ovar-
symptoms.
ian cancer, though it is a symptom of cervical and uterine
Risk factors: Known risk factors include tobacco use in any cancers.
form (smoked and smokeless) and excessive alcohol consump-
Risk factors: The most important risk factor is a strong family
tion. Many studies have reported a synergistic relationship
history of breast or ovarian cancer. Women who have had breast
between smoking and alcohol, resulting in a 30-fold increased
cancer or who have tested positive for inherited mutations in
risk for individuals who both smoke and drink heavily. HPV
ovarian cancer susceptibility genes, such as BRCA1 or BRCA2,
infection of the mouth and throat, believed to be transmitted
are at increased risk. Preventive surgery to remove the ovaries
through sexual contact, also increases risk.
and fallopian tubes in these women decreases the risk of ovarian
Early detection: Cancer can affect any part of the oral cavity, cancer. Other medical conditions associated with increased risk
including the lip, tongue, mouth, and throat. Visual inspection include pelvic inflammatory disease and Lynch syndrome. The

Table 7. Trends in 5-year Relative Survival Rates* (%) by Race, US, 1975-2011
All races White Black
1975-77 1987-89 2005-11 1975-77 1987-89 2005-11 1975-77 1987-89 2005-11
All sites 49 55 69 50 57 70 39 43 62
Brain & other nervous system 22 29 35 22 28 33 25 32 40
Breast (female) 75 84 91 76 85 92 62 71 81
Colon & rectum 50 60 66 50 60 67 45 52 59
Esophagus 5 10 20 6 11 21 4 7 14
Hodgkin lymphoma 72 79 88 72 80 89 70 72 86
Kidney & renal pelvis 50 57 74 50 57 74 49 55 74
Larynx 66 66 63 67 67 65 58 56 51
Leukemia 34 43 62 35 44 63 33 35 55
Liver & intrahepatic bile duct 3 5 18 3 6 18 2 3 13
Lung & bronchus 12 13 18 12 13 19 11 11 16
Melanoma of the skin 82 88 93 82 88 93 57 79 70
Myeloma 25 27 49 24 27 48 30 30 50
Non-Hodgkin lymphoma 47 51 72 47 51 73 49 46 64
Oral cavity & pharynx 53 54 66 54 56 68 36 34 45
Ovary 36 38 46 35 38 46 42 34 38
Pancreas 3 4 8 3 3 8 2 6 7
Prostate 68 83 99 69 84 >99 61 71 98
Stomach 15 20 30 14 18 29 16 19 28
Testis 83 95 97 83 95 97 73 88 91
Thyroid 92 94 98 92 94 99 90 92 97
Urinary bladder 72 79 79 73 80 79 50 63 67
Uterine cervix 69 70 69 70 73 71 65 57 60
Uterine corpus 87 82 83 88 84 85 60 57 66
*Rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 9 areas from 1975 to 1977, 1987 to 1989, and 2005 to 2011, all followed
through 2012. The difference between the 1975-1977 and 2005-2011 rates is statistically significant (p<0.05). The standard error is between 5 and 10 percentage
points. Survival rate is for cases diagnosed from 1978 to 1980.
Source: Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute, Bethesda, MD,
http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER website April 2015.
use of menopausal hormone therapy (estrogen alone and estro- ing ovarian cancer mortality when used as a screening tool in
gen combined with progesterone) also increases risk. Tobacco average-risk women.
smoking increases the risk of a rare type of ovarian cancer
Treatment: Treatment includes surgery and often chemother-
(mucinous). Pregnancy, long-term use of oral contraceptives,
apy. Surgery usually involves removal of both ovaries and
and tubal ligation reduce risk.
fallopian tubes (salpingo-oophorectomy), the uterus (hysterec-
Early detection: There is currently no sufficiently accurate tomy), and the omentum (fatty tissue attached to some of the
screening test for the early detection of ovarian cancer in aver- organs in the belly), along with biopsies of the peritoneum (lin-
age-risk women. A pelvic exam, sometimes in combination with ing of the abdominal cavity). In younger women with very early
a transvaginal ultrasound, may be used to evaluate women with stage tumors who want to preserve fertility, only the involved
symptoms, but only occasionally detects ovarian cancer, gener- ovary and fallopian tube may be removed. Among patients with
ally when the disease is advanced. For women who are at high early ovarian cancer, more accurate surgical staging (micro-
risk, a thorough pelvic exam in combination with transvaginal scopic examination of tissue from different parts of the pelvis and
ultrasound and a blood test for the tumor marker CA125 may be abdomen) has been associated with better outcomes. For some
offered, although this strategy has not proven effective in reduc- women with advanced disease, chemotherapy administered

directly into the abdomen improves survival; however, in 2012, those who undergo surgery, adjuvant treatment with chemother-
less than half of eligible women received this treatment. Tar- apy (and sometimes radiation) may lower the risk of recurrence.
geted drugs can sometimes be used after other treatments to For advanced disease, chemotherapy (sometimes along with a
shrink tumors or slow growth of advanced cancers. targeted therapy drug) may lengthen survival. Clinical trials are
testing whether several new agents offer improved survival.
Survival: Overall, the 5- and 10-year relative survival rates for
ovarian cancer patients are 46% and 35%, respectively. However, Survival: For all stages combined, the 1- and 5-year relative sur-
survival varies substantially by age; women younger than 65 are vival rates are 29% and 7%, respectively. Even for the small
twice as likely to survive 5 years as women 65 and older (58% percentage of people diagnosed with local disease (9%), the
versus 28%). Overall, only 15% of cases are diagnosed at a local 5-year survival is only 27%. More than half (53%) of patients are
stage, for which 5-year survival is 92%. diagnosed at a distant stage, for which 1- and 5-year survival is
15% and 2%, respectively. Five-year relative survival is substan-
tially higher for neuroendocrine (53%) than exocrine (5%) tumors.
Pancreas
New cases: An estimated 53,070 new cases of pancreatic cancer
are expected to occur in the US in 2016. Most (95%) will be can- Prostate
cers of the exocrine pancreas, which produces enzymes to digest New cases: An estimated 180,890 new cases of prostate cancer
food. Much rarer are neuroendocrine tumors (5%), which have a will occur in the US during 2016. Prostate cancer is the most fre-
younger median age at diagnosis and better prognosis. quently diagnosed cancer in men aside from skin cancer. For
reasons that remain unclear, the risk of prostate cancer is 70%
Incidence trends: Pancreatic cancer incidence rates increased
higher in blacks than in non-Hispanic whites.
by 1.2% per year from 2000 through 2012.
Incidence trends: In the late 1980s and early 1990s, incidence
Deaths: An estimated 41,780 deaths from pancreatic cancer will
rates for prostate cancer spiked dramatically, in large part
occur in 2016, with similar numbers in men (21,450) and women
because of widespread screening with the prostate-specific
(20,330).
antigen (PSA) blood test. From 2003 to 2012, rates decreased by
Mortality trends: Death rates for pancreatic cancer have 4.0% per year.
increased by 0.4% per year since 2000.
Deaths: With an estimated 26,120 deaths in 2016, prostate can-
Signs and symptoms: Symptoms for pancreatic cancer, which cer is the second-leading cause of cancer death in men.
usually do not appear until the disease has progressed, include
Mortality trends: Prostate cancer death rates have been
weight loss, abdominal discomfort that may radiate to the back,
decreasing since the early 1990s in men of all races/ethnicities,
and occasionally the development of diabetes. Tumors that
although they remain more than twice as high in blacks as in
develop near the common bile duct can cause jaundice (yellow-
any other group (see Table 9, page 51). Overall, prostate can-
ing of the skin and eyes), which sometimes allows the tumor to
cer death rates decreased by 3.5% per year from 2003 to 2012.
be diagnosed at an early stage. Signs of advanced stage disease
These declines are due to improvements in early detection and
may include severe abdominal pain, nausea, and vomiting.
treatment.
Risk factors: The risk of pancreatic cancer in cigarette smokers
Signs and symptoms: Early prostate cancer usually has no
is about twice that for never smokers. Use of smokeless tobacco
symptoms. With more advanced disease, men may experience
also increases risk. Other risk factors include a family history of
weak or interrupted urine flow; difficulty starting or stopping
pancreatic cancer, a personal history of chronic pancreatitis or
the urine flow; the need to urinate frequently, especially at night;
diabetes, and obesity. Individuals with Lynch syndrome and cer-
blood in the urine; or pain or burning with urination. Advanced
tain other genetic syndromes, and BRCA1 and BRCA2 mutation
prostate cancer commonly spreads to the bones, which can
carriers, are also at increased risk.
cause pain in the hips, spine, ribs, or other areas.
Early detection: There is currently no reliable method for the
Risk factors: The only well-established risk factors for prostate
early detection of pancreatic cancer.
cancer are increasing age, African ancestry, a family history of
Treatment: Surgery, radiation therapy, and chemotherapy are the disease, and certain inherited genetic conditions. Black men
treatment options that may extend survival and/or relieve symp- in the US and Caribbean men of African descent have the high-
toms, but seldom produce a cure. Less than 20% of patients are est documented prostate cancer incidence rates in the world.
candidates for surgery because pancreatic cancer is usually Genetic studies suggest that strong familial predisposition may
detected after it has spread beyond the pancreas. Even among be responsible for 5%-10% of prostate cancers. Inherited condi-
patients who are thought to be surgical candidates, the cancer is tions associated with increased risk include Lynch syndrome
often found to have spread too extensively to be removed. For and BRCA1 and BRCA2 mutations. Studies suggest that obesity

and smoking do not increase the overall risk of developing effective, although recent studies have shown that adding che-
prostate cancer, but may increase risk of developing aggressive/ motherapy to initial hormone therapy may lengthen survival.
fatal disease. An option for some men with advanced prostate cancer that is
no longer responding to hormones is a cancer vaccine designed
Prevention: The chemoprevention of prostate cancer is an
to stimulate the patients immune system to specifically attack
active area of research. Two drugs of interest, finasteride and
prostate cancer cells. Newer forms of hormone therapy have
dutasteride, reduce the amount of certain male hormones in the
been shown to be beneficial for the treatment of metastatic dis-
body and are approved to treat the symptoms of benign pros-
ease that is resistant to initial hormone therapy and/or
tatic hyperplasia. Although these drugs also seem to reduce
chemotherapy. Other types of drugs can be used to treat pros-
prostate cancer risk, neither is approved for the prevention of
tate cancer that has spread to the bones.
prostate cancer because they have not been shown to improve
overall or prostate cancer-specific survival and also have impor- Survival: The majority (92%) of prostate cancers are discovered
tant side effects (e.g., erectile dysfunction). at a local or regional stage, for which the 5-year relative survival
rate approaches 100%. Over the past 25 years, the 5-year relative
Early detection: No organizations presently endorse routine
survival rate for all stages combined has increased from 68% to
prostate cancer screening for men at average risk because of
99% (Table 8, page 21), some of which is due to the detection of
concerns about the high rate of overdiagnosis, along with the
indolent disease. According to the most recent data, 10- and
significant potential for serious side effects associated with
15-year relative survival rates are 98% and 95%, respectively.
prostate cancer treatment. The American Cancer Society rec-
ommends that beginning at age 50, men who are at average risk
of prostate cancer and have a life expectancy of at least 10 years Skin
have a conversation with their health care provider about the New cases: Skin cancer is the most commonly diagnosed cancer
benefits and limitations of PSA testing. Men should have an in the US. However, the actual number of the most common
opportunity to make an informed decision about whether to be types basal cell and squamous cell skin cancer (i.e., keratino-
tested based on their personal values and preferences. Men at cyte carcinoma or KC), also referred to as nonmelanoma skin
high risk of developing prostate cancer (black men or those with cancer is very difficult to estimate because these cases are not
a close relative diagnosed with prostate cancer before the age of required to be reported to cancer registries. The most recent
65) should have this discussion beginning at age 45, and men at study of KC occurrence estimated that in 2012, 5.4 million cases
even higher risk (those with several close relatives diagnosed at were diagnosed among 3.3 million people (many people are
an early age) should have this discussion at age 40. diagnosed with more than one KC).
Treatment: Treatment options vary depending on age, stage, An estimated 76,380 new cases of melanoma will be diagnosed
and grade of cancer, as well as other medical conditions. Careful in 2016. Melanoma accounts for only 1% of all skin cancer cases,
observation (called active surveillance) instead of immediate but the vast majority of skin cancer deaths. It is most commonly
treatment is appropriate for many patients, particularly those diagnosed in non-Hispanic whites; the annual incidence rate is 1
diagnosed at an early stage or with less aggressive tumors and (per 100,000) in blacks, 4 in Hispanics, and 25 in non-Hispanic
for older men. Treatment options include surgery (open, laparo- whites. Incidence rates are higher in women than in men before
scopic, or robotic-assisted), external beam radiation, or age 50, but by age 65, rates in men are double those in women,
radioactive seed implants (brachytherapy). Hormonal therapy and by age 80 they are triple. This pattern reflects differences in
may be used along with surgery or radiation therapy in more occupational and recreational exposure to ultraviolet radiation
advanced cases. Treatment often impacts a mans quality of life by sex and age, which have changed over time.
due to side effects or complications, such as urinary and erectile
difficulties, which may be short or long term. Current research is Incidence trends: Overall, the incidence of cutaneous mela-
exploring new biologic markers for prostate cancer in order to noma has risen rapidly over the past 30 years. However, the past
improve the distinction between indolent and aggressive dis- 5 years of data indicate that rates are declining or plateauing
ease to minimize unnecessary treatment. among those younger than 50. For example, from 2008 to 2012,
incidence rates declined by about 3% per year in both men and
Distant stage disease is treated with hormonal therapy, chemo- women ages 20-29. In contrast, among adults 50 and older, the
therapy, radiation therapy, and/or other treatments. Hormone incidence rate has increased by 2.6% per year since 1996.
treatment may control advanced prostate cancer for long peri-
ods of time by shrinking the size or limiting the growth of Deaths: In 2016, an estimated 10,130 deaths from melanoma
the cancer, thus helping to relieve pain and other symptoms. and 3,520 deaths from other types of skin cancer (not including
Chemotherapy is often used if hormone treatments are no longer KC) will occur.

Table 8. Five-year Relative Survival Rates* (%) by Stage at Diagnosis, US, 2005-2011
All stages Local Regional Distant All stages Local Regional Distant
Breast (female) 89 99 85 26 Ovary 46 92 73 28
Colon & rectum 65 90 71 13 Pancreas 7 27 11 2
Esophagus 18 40 22 4 Prostate 99 >99 >99 28
Kidney 73 92 65 12 Stomach 29 65 30 5
Larynx 61 76 45 35 Testis 95 99 96 74
Liver 17 31 11 3 Thyroid 98 >99 98 54
Lung & bronchus 17 55 27 4 Urinary bladder 77 70 34 5
Melanoma of the skin 92 98 63 17 Uterine cervix 68 92 57 17
Oral cavity & pharynx 63 83 62 38 Uterine corpus 82 95 68 17
*Rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 18 areas from 2005-2011, all followed through 2012. Includes renal pelvis.
Includes intrahepatic bile duct. Rate for in situ cases is 96%.
Local: an invasive malignant cancer confined entirely to the organ of origin. Regional: a malignant cancer that 1) has extended beyond the limits of the organ of origin
directly into surrounding organs or tissues; 2) involves regional lymph nodes; or 3) has both regional extension and involvement of regional lymph nodes. Distant: a
malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues,
or via the lymphatic system to distant lymph nodes.
Source: Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute, Bethesda, MD,
http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER website April 2015.
Mortality trends: Although overall mortality rates have been Prevention: Minimize skin exposure to intense UV radiation by
stable since the late 1980s, these trends also vary by age. While seeking shade; wearing protective clothing (long sleeves, long
rates in individuals younger than 50 have been declining by 2.6% pants or skirts, tightly woven fabric, and a wide-brimmed hat);
per year since 1986, they have been increasing by 0.6% per year wearing sunglasses that block ultraviolet rays; applying broad-
since 1990 among those 50 and older. spectrum sunscreen that has a sun protection factor (SPF) of 30
or higher to unprotected skin; and not sunbathing or indoor tan-
Signs and symptoms: Warning signs of skin cancer include
ning. Children should be especially protected from the sun
changes in the size, shape, or color of a mole or other skin lesion,
because severe sunburns in childhood may greatly increase the
the appearance of a new growth on the skin, or a sore that doesnt
risk of melanoma. In July 2014, the US Surgeon General released
heal. Changes that progress over a month or more should be
a Call to Action to Prevent Skin Cancer, citing the elevated and
evaluated by a health care provider. Basal cell carcinoma may
growing burden of this disease. The purpose of this initiative is
appear as a growth that is flat, or as a small, raised pink or red
to increase awareness and encourage all Americans to engage in
translucent, shiny area that may bleed following minor injury.
behaviors that reduce the risk of skin cancer. See surgeongeneral.
Squamous cell carcinoma may appear as a growing lump, often
gov/library/calls/prevent-skin-cancer/call-to-action-prevent-skin-
with a rough surface, or as a flat, reddish patch that grows
cancer.pdf for more information.
slowly.
Early detection: The best way to detect skin cancer early is to
Risk factors: For melanoma, major risk factors include a per-
recognize new or changing skin growths, particularly those that
sonal or family history of melanoma and the presence of atypical,
look different from other moles. All major areas of the skin
large, or numerous (more than 50) moles. High exposure to
should be examined regularly, and any new or unusual lesions,
ultraviolet (UV) radiation, from sunlight or use of indoor tan-
or a progressive change in a lesions appearance (size, shape, or
ning, is a major risk factor for all types of skin cancer. (The
color, etc.), should be evaluated promptly by a physician. The
International Agency for Research on Cancer has classified
ABCDE rule outlines warning signs of the most common type of
indoor tanning devices as carcinogenic to humans based on an
melanoma: A is for asymmetry (one half of the mole does not
extensive review of scientific evidence.) People at highest risk
match the other half); B is for border irregularity (the edges are
include those with sun sensitivity (e.g., sunburning easily, diffi-
ragged, notched, or blurred); C is for color (the pigmentation is
culty tanning, or natural blond or red hair color); a history of
not uniform, with variable degrees of tan, brown, or black); D is
excessive sun exposure, including sunburns; diseases or treat-
for diameter greater than 6 millimeters (about the size of a pen-
ments that suppress the immune system; and a past history of
cil eraser); and E is for evolution. Not all melanomas have these
skin cancer.
signs, so be alert for any new or changing skin growths or spots.

Treatment: Most early skin cancers are diagnosed and treated Risk factors: Risk factors for thyroid cancer include being
by removal and microscopic examination of the cells. Early stage female, having a history of goiter (enlarged thyroid) or thyroid
KC can be treated in most cases by one of several methods: surgi- nodules, a family history of thyroid cancer, and radiation expo-
cal excision, electrodessication and curettage (tissue destruction sure early in life (e.g., as a result of medical treatment). People
by electric current and removal by scraping with a curette), or who test positive for a mutation in a gene called RET, which
cryosurgery (tissue destruction by freezing). Radiation therapy causes a hereditary form of thyroid cancer (familial medullary
and certain topical medications may be used. For melanoma, thyroid carcinoma), can lower their risk of developing the dis-
the primary growth and surrounding normal tissue are removed ease by having the thyroid gland surgically removed. Certain
and sometimes a sentinel lymph node is biopsied to determine rare genetic syndromes, such as familial adenomatous polyposis
stage. More extensive lymph node surgery may be needed if the (FAP), also increase risk. Unlike most other adult cancers, for
sentinel lymph nodes contain cancer. Melanomas with deep which older age increases risk, 70% of cases are diagnosed in
invasion or that have spread to lymph nodes may be treated with patients younger than age 60.
surgery, immunotherapy, chemotherapy, and/or radiation ther-
Early detection: At present, there is no screening test recom-
apy. The treatment of advanced melanoma has changed greatly
mended for the early detection of thyroid cancer. However,
in recent years with the FDA approval of several new immuno-
because symptoms usually develop early and many cancers are
therapy and targeted drugs, which shrink a large portion of
found incidentally, two-thirds of thyroid cancers are diagnosed
melanomas. Chemotherapy might be used, although it is usually
at an early stage.
less effective than newer treatments.
Treatment: Most thyroid cancers are highly curable, though
Survival: Almost all cases of KC can be cured, especially if the
about 5% (medullary and anaplastic thyroid cancers) are more
cancer is detected and treated early. Although melanoma is also
aggressive and more likely to spread to other organs. Treatment
highly curable when detected in its earliest stages, it is more likely
depends on the cell type, tumor size, and extent of disease. The
than KC to spread to other parts of the body. The 5- and 10-year
first choice of treatment is usually surgery to partially or totally
relative survival rates for people with melanoma are 92% and 89%,
remove the thyroid gland (thyroidectomy) and sometimes
respectively. The 5-year survival rate is 98% for localized mela-
nearby lymph nodes. Treatment with radioactive iodine (I-131)
noma (84% of cases), but declines to 63% and 17% for regional and
after complete thyroidectomy to destroy any remaining thyroid
distant stage disease, respectively (Table 8, page 21).
tissue may be recommended for large tumors or when cancer
has spread outside the thyroid. Thyroid hormone replacement
Thyroid therapy is given after thyroidectomy to replace hormones nor-
New cases: An estimated 64,300 new cases of thyroid cancer are mally made by the thyroid gland and to prevent the body from
expected to be diagnosed in 2016 in the US, with 3 out of 4 cases making thyroid-stimulating hormone, decreasing the likelihood
occurring in women. of recurrence. For some types of advanced thyroid cancer, tar-
geted drugs can be used to help shrink or slow tumor growth.
Incidence trends: Thyroid cancer has been increasing world-
wide over the past few decades and is the most rapidly increasing Survival: The 5-, 10-, and 15-year relative survival rates are 98%,
cancer in the US. The rise is thought to be partly due to increased 97%, and 95% respectively. However, survival varies by stage
detection because of more sensitive diagnostic procedures, (Table 8, page 21), age at diagnosis, and disease subtype.
likely resulting in some overdiagnoses. In the US, rates increased
by 5.1% per year from 2003 to 2012. Urinary Bladder
Deaths: An estimated 1,980 deaths from thyroid cancer are New cases: An estimated 76,960 new cases of bladder cancer are
expected in 2016. expected to occur in 2016. Bladder cancer incidence is about 4
times higher in men than in women and almost 2 times higher in
Mortality trends: Death rates for thyroid cancer were stable from
white men than in black men.
2003 to 2012.
Incidence trends: After decades of slowly increasing, bladder
Signs and symptoms: The most common symptom of thyroid
cancer incidence has begun to decline. From 2003 to 2012, rates
cancer is a lump in the neck that is noticed by a patient or felt by
decreased by 0.5% per year.
a clinician during an exam. Other symptoms include a tight or
full feeling in the neck, difficulty breathing or swallowing, Deaths: An estimated 16,390 deaths will occur in 2016.
hoarseness, swollen lymph nodes, and pain in the throat or neck
Mortality trends: Death rates for urinary bladder cancer have
that does not go away. Many thyroid cancers are diagnosed in
been stable since 1987 in men and decreasing by 0.4% per year
people without symptoms because an abnormality is seen on an
since 1986 in women.
imaging test performed for another purpose.

Signs and symptoms: Bladder cancer is usually detected early Mortality trends: Like incidence, the cervical cancer death rate
because of blood in the urine or other symptoms, including in 2012 (2.3 per 100,000) was less than half that in 1975 (5.6 per
increased frequency or urgency of urination or pain or irritation 100,000) due to declines in incidence and the early detection of
during urination. cancer with the Pap test. However, the magnitude of the decline
has begun to slow in recent years in women of all ages, indicat-
Risk factors: Smoking is the most well-established risk factor
ing that rates may be approaching a lower limit; from 2003 to
for bladder cancer, accounting for about half of all cases. Risk is
2012, the death rate decreased by 0.9% per year.
also increased among workers in the dye, rubber, leather, and
aluminum industries; painters; people who live in communities Signs and symptoms: Preinvasive cervical lesions often have
with high levels of arsenic in the drinking water; and people no symptoms. Once abnormal cervical cells become cancerous
with certain bladder birth defects. and invade nearby tissue, the most common symptom is abnor-
mal vaginal bleeding, which may start and stop between regular
Early detection: There is currently no screening method rec-
menstrual periods or occur after sexual intercourse, douching,
ommended for people at average risk. Bladder cancer is
or a pelvic exam. Menstrual bleeding may last longer and be
diagnosed by microscopic examination of cells from urine or
heavier than usual. Bleeding after menopause and increased
bladder tissue and examination of the bladder wall with a cysto-
vaginal discharge may also be symptoms.
scope, a slender tube fitted with a lens and light that is inserted
through the urethra. These and other tests may be used to screen Risk factors: Most cervical cancers are caused by persistent
people at increased risk, as well as during follow-up after blad- infection with certain types of human papillomavirus (HPV).
der cancer treatment to detect recurrent or new tumors. While women who begin having sex at an early age or who have
had many sexual partners are at increased risk for HPV infec-
Treatment: Surgery, alone or in combination with other treat-
tion and cervical cancer, a woman may be infected with HPV
ments, is used in more than 90% of cases. Early stage cancers
even if she has had only one sexual partner. In fact, HPV infec-
may be treated by removing the tumor and then administering
tions are common in healthy women and only rarely cause
immunotherapy or chemotherapy drugs directly into the blad-
cervical cancer. Both persistence of HPV infection and progres-
der. More advanced cancers may require removal of the entire
sion to cancer may be influenced by many factors, including a
bladder (cystectomy). Patient outcomes are improved with the
suppressed immune system, a high number of childbirths, and
use of chemotherapy, alone or with radiation, before cystectomy.
cigarette smoking. Long-term use of oral contraceptives (birth
Timely follow-up care is extremely important because of the
control pills) is also associated with increased risk of cervical
high rate of bladder cancer recurrence.
cancer.
Survival: For all stages combined, the 5-year relative survival
Prevention: Vaccines are available to protect against the most
rate is 77%. Survival declines to 70% at 10 years and 65% at 15
common types of HPV that cause cervical cancer. Vaccination is
years after diagnosis. Half of all bladder cancer patients are
recommended for use in girls 11 to 12 years of age, but may be
diagnosed while the tumor is in situ (noninvasive, present only
given as young as age 9 and up to age 26. HPV vaccines cannot
in the layer of cells in which the cancer developed), for which the
protect against established infections, nor do they protect
5-year survival is 96%.
against all types of HPV, which is why vaccinated women should
still be screened for cervical cancer.
Uterine Cervix Screening can prevent cervical cancer by detecting precancer-
New cases: An estimated 12,990 cases of invasive cervical can- ous lesions that can be treated so they do not progress to cancer.
cer are expected to be diagnosed in 2016. As screening has become more common, precancerous lesions
Incidence trends: The cervical cancer incidence rate declined of the cervix are detected far more frequently than invasive can-
by half between 1975 (14.8 per 100,000) and 2012 (6.7 per 100,000) cer. The Pap test is a simple procedure in which a small sample
due to the widespread uptake of screening with the Pap test and of cells is collected from the cervix and examined under a micro-
removal of precancerous lesions. However, declines in younger scope. HPV tests, which detect HPV infections associated with
women have begun to slow in recent years. From 2008 to 2012, cervical cancer, can forecast cervical cancer risk many years in
incidence rates stabilized in women younger than 50 years of the future and are currently recommended to be used in con-
age and decreased by 3.0% per year among in women 50 or older. junction with the Pap test in some women, either as an additional
screening test or when Pap test results are uncertain. HPV tests
Deaths: An estimated 4,120 deaths from cervical cancer will can also identify women at risk for an uncommon type of cervi-
occur in 2016. cal cancer (adenocarcinoma) that is often missed by Pap tests.

Most cervical precancers develop slowly, so cancer can usually Incidence trends: Incidence rates have been increasing among
be prevented if a woman is screened regularly. It is important for women younger than 50 years of age by 1.3% per year since 1988
all women, even those who have received the HPV vaccine, to and among women 50 and older by 1.9% per year since 2005.
follow cervical cancer screening guidelines.
Deaths: An estimated 10,470 deaths are expected in 2016.
Early detection: In addition to preventing cervical cancer,
Mortality trends: From 2003 to 2012, death rates for cancer of
screening can detect invasive cancer early, when treatment is
the uterine corpus increased by 1.1% per year.
most likely to be successful. Most women diagnosed with cervi-
cal cancer have never or not recently been screened. The Signs and symptoms: Abnormal uterine bleeding or spotting
American Cancer Society, in collaboration with the American (especially in postmenopausal women) is a frequent early sign.
Society for Colposcopy and Cervical Pathology and the Ameri- Pain during urination, intercourse, or in the pelvic area can also
can Society for Clinical Pathology, issued new screening be a symptom.
guidelines for the prevention and early detection of cervical can-
Risk factors: Obesity and abdominal fatness increase the risk of
cer in 2012. The most important changes to the guidelines were
uterine cancer, most likely by increasing the amount of circulat-
the age range for which screening is appropriate (ages 21 to 65)
ing estrogen, which is a strong risk factor. Other factors that
and the emphasis on the incorporation of HPV testing in addi-
increase estrogen exposure include menopausal estrogen ther-
tion to the Pap test (for ages 30 to 65). For more detailed
apy, late menopause, never having children, and a history of
information on the American Cancer Societys screening guide-
polycystic ovary syndrome. (Estrogen plus progestin meno-
lines for the early detection of cervical cancer, see page 66.
pausal hormone therapy does not appear to increase risk.)
Treatment: Precancerous cervical lesions may be treated with a Tamoxifen, a drug used to treat breast cancer, increases risk
loop electrosurgical excision procedure (LEEP), which removes slightly because it has estrogen-like effects on the uterus. Medi-
abnormal tissue with a wire loop heated by electric current; cal conditions that increase risk include Lynch syndrome and
cryotherapy (the destruction of cells by extreme cold); laser abla- diabetes. Pregnancy, use of oral contraceptives or intrauterine
tion (removal of tissue); or conization (the removal of a devices, and physical activity are associated with reduced risk.
cone-shaped piece of tissue containing the abnormal tissue).
Early detection: There is no standard or routine screening test
Invasive cervical cancers are generally treated with surgery or
for women at average risk. Most cases (67%) are diagnosed at an
radiation combined with chemotherapy. Chemotherapy alone is
early stage because of postmenopausal bleeding. Women are
often used to treat advanced disease. However, for women with
encouraged to report any unexpected bleeding or spotting to
metastatic, recurrent, or persistent cervical cancer, the addition
their physicians. The American Cancer Society recommends
of targeted therapy to standard chemotherapy has been shown
that women with known or suspected Lynch syndrome be
to improve overall survival.
offered annual screening with endometrial biopsy and/or trans-
Survival: Five- and 10-year relative survival rates for cervical vaginal ultrasound beginning at age 35.
cancer patients are 68% and 64%, respectively. Almost half of
Treatment: Uterine cancers are usually treated with surgery,
patients (46%) are diagnosed when the cancer is localized, for
radiation, hormones, and/or chemotherapy, depending on the
which the 5-year survival is 92% (Table 8, page 21).
stage of disease.
Survival: The 5- and 10-year relative survival rates for uterine
Uterine Corpus (Endometrium) cancer are 82% and 79%, respectively. The 5-year survival is sub-
New cases: An estimated 60,050 cases of cancer of the uterine stantially higher for whites (84%) than for blacks (62%). This is
corpus (body of the uterus) are expected to be diagnosed in 2016. partly because white women are more likely than black women
Cancer of the uterine corpus is often referred to as endometrial to be diagnosed with local stage disease (69% versus 53%).
cancer because most cases (92%) occur in the endometrium (lin-
ing of the uterus).

Native Hawaiians, and Pacific Islanders
Introduction The largest Asian subpopulation in the US is Chinese (23%), fol-
lowed by Filipino (20%), Asian Indian (18%), Vietnamese (10%),
Asian Americans are the fastest-growing racial/ethnic group in
Korean (10%), Japanese (8%), and 2% or less for Pakistani, Cambo-
the US, representing 6.3% of the population (20.0 million/318.7
dian, Hmong, and other groups.4 The largest NHPI subpopulation
million) in 2014.1 In contrast to Hispanics, the rapid growth of
is Native Hawaiian (43%), followed by Samoan (15%), Guamanian
the Asian American population is driven by immigration as
or Chamorro (12%), and Tongan (5%).3 Ten US states are home to
opposed to native births.2 The Native Hawaiian and Pacific
73% of the overall AANHPI population (Figure S1); California
Islander (NHPI) population (1.5 million) is also among the fastest-
has the largest population with 32%, followed by New York (9%),
growing groups.1, 3 The term Asian refers to people with origins
Texas (7%), Hawaii (5%), and New Jersey (5%). Notably, AANHPIs
in the Far East, Southeast Asia, or the Indian subcontinent and
comprise 71% and 15% of the total population in Hawaii and
includes, but is not limited to, Asian Indian, Cambodian, Chinese,
California, respectively. AANHPI populations are generally con-
Filipino, Hmong, Japanese, Korean, Pakistani, and Vietnamese.4
centrated in urban areas.
The term NHPI refers to people with origins in Hawaii, Guam,
Samoa, or other Pacific Islands.3 According to the US Census, a
person may be Asian American or NHPI alone or in combination Sociodemographic Characteristics
with other races.3, 4 While Asian Americans and NHPIs are distinct AANHPI subgroups have highly heterogeneous demographic
racial groups with very different cancer profiles, unfortunately characteristics. For example, the median age among the largest
demographic and health data are usually available only in aggre- subgroups ranges from 22 in Hmong to 37 in Japanese (Table S1,
gate. These two groups are collectively referred to as Asian page 26). Some groups are largely composed of native-born US
American, Native Hawaiian, and Pacific Islander (AANHPI), Asian citizens, such as Native Hawaiians (98%), Samoans (91%), and
American and Pacific Islander (AAPI), or Asian and Pacific Japanese (75%), while others are more likely to be foreign-born,
Islander (API). such as Asian Indians (68%). Longer duration in the US is gener-
ally associated with the adoption of an American lifestyle, which
can influence the prevalence of cancer risk factors, such as
Figure S1. AANHPI Population by State, 2013 smoking and excess body weight.5, 6 In addition, the ability to
access preventive and health care services can be hampered by
language barriers.7 About 50% of Vietnamese and 40% of Chinese,
Other
27% California Koreans, Cambodians, and Hmong report speaking a language
32%
other than English at home and speaking English less than very
well (Table S1, page 26).
The variation in socioeconomic status between AANHPI sub-
groups is striking.8 For example, more than one-third of Japanese,
Massachusetts Filipinos, and Asian Indians have a bachelors degree or higher
2%
and only about 5% live in poverty, compared to 12% and 20%,
Virginia
3% respectively, of Cambodians and Hmong (Table S1, page 26).
Florida
3%
Washington
New York
9% Overall cancer statistics
3%
Illinois Cancer patterns in AANHPIs are more similar to Hispanics than
4% New Jersey Texas
Hawaii 7% NHWs, with lower rates for the most common cancers and
5% 5%
higher rates for cancers associated with infectious agents. How-
ever, cancer rates within the AANHPI population vary by
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. immigration history, origin, acculturation, and socioeconomic
Source: US Census Bureau Population Estimates Program, modified in
collaboration with the National Center for Health Statistics with support from status. For example, lung cancer incidence rates range from 21.1
the National Cancer Institute, accessed through Surveillance, Epidemiology, (per 100,000) in Asian Indian/Pakistani men to 98.9 in Samoan
and End Results (SEER) Program, 2015.
men; these distinctions are masked in aggregated statistics.

Table S1. Sociodemographic Characteristics of AANHPIs by Subgroup, 2011-2013
Total Asian Native
Asian Chinese Filipino Indian Vietnamese Korean Japanese Pakistani Cambodian Hmong Laotian Hawaiian Samoan
Median age 34 35 34 32 35 34 37 29 29 22 29 27 23
Nativity and citizenship (%)
Native 41 39 49 32 37 39 75 37 47 61 51 98 91
Foreign-born, naturalized citizen 34 36 34 34 47 35 8 38 36 27 34 1 5
Foreign-born, not a citizen 25 25 17 34 16 26 17 25 17 12 15 1 4
Average household size (n of persons) 3.1 2.9 3.4 3.1 3.5 2.7 2.4 4.0 3.9 5.1 3.8 3.2 4.1
Language spoken at home and

English-speaking ability (%)
Only English spoken at home 31 26 46 24 17 32 68 16 25 12 26 89 58
Non-English at home 69 74 55 76 83 68 32 84 75 88 75 11 43
Non-English at home, English

spoken less than "very well" 31 41 18 21 49 38 15 27 39 38 35 2 11
Poverty (%) 10 11 6 6 14 12 5 16 20 25 15 13 17
Per capita income ($) 29,630 31,382 26,514 40,221 22,234 27,088 32,923 25,135 16,472 11,938 17,183 20,740 15,021
Educational attainment (%)
Less than high school graduate 14 18 7 9 29 7 5 13 35 33 31 9 12
High school graduate 16 15 16 9 22 18 19 15 25 23 30 36 37
Some college or associate's degree 21 16 31 11 23 22 29 18 25 28 26 35 37
Bachelor's degree or higher 29 26 37 32 19 34 31 30 12 13 10 14 10
AANHPI = Asian American, Native Hawaiian, and Pacific Islander.

Source: US Census Bureau, 2011-2013 3-Year American Community Survey.
Cancer is the leading cause of death among AANHPIs, accounting Overall cancer incidence rates declined from 2003 to 2012 (the
for 27% of all deaths (Table S2, page 28). Among non-Hispanic most recent 10 years for which data are currently available)
whites, heart disease remains the leading cause of death, followed among AANHPI males by 1.9% annually, compared with declines
by cancer. However, the cancer death rate in AANHPIs (104.2 per of 1.5% annually among NHW males.9 During the same period,
100,000) is about 40% lower than that in NHWs (170.2). incidence rates remained stable among both AANHPI and NHW
females (Figure S5, page 32). However, mortality rates during
The lifetime probability of developing cancer among AANHPIs is
this period declined among both AANHPI males and females by
36% in males and 33% in females (Table S3, page 29), compared
1.5% and 0.8% annually, respectively, similar to the declines in
to 42% and 38% in NHW males and females, respectively. In 2016,
NHWs.10 Trends in cancer occurrence among Asian Americans
an estimated 57,740 new cancer cases and 16,910 cancer deaths
are influenced not only by the risk factor profiles of those living
will occur among AANHPIs. According to these estimates, the
in the US, but also by the influx of immigrants.
most commonly diagnosed cancers among males are prostate
(18%), lung (14%), and colorectum (12%) (Figure S2, page 29). Overall five-year cancer survival among AANHPIs compared
Among females, the most common cancers are breast (34%), thy- with NHWs is lower for males (62% versus 68%) and similar for
roid (10%), and lung (9%). The three leading causes of cancer females (70% versus 68%; Figure S6, page 33). Survival is notably
death are lung (27%), liver (14%), and colorectum (11%) among higher among AANHPIs for stomach, liver, and nasopharyngeal
males, and lung (21%), breast (14%), and colorectum (11%) among cancers, while it is similar for other major cancer sites (Figure
females. S6, page 33). Survival statistics for minority groups in the US
are particularly influenced by incomplete follow-up of cancer
As mentioned previously, there is substantial variation in cancer
patients due to lost contact or inability to link to death registries,
occurrence among AANHPI subgroups. For both males and
artificially inflating rates by as much as 6 percentage points
females, Samoans and Native Hawaiians have the highest over-
among Asian Americans.11 Lost contact of cancer patients is
all cancer incidence rates, while Asian Indians and Pakistanis
sometimes the result of terminally ill people returning to their
(grouped together) and Cambodians have the lowest rates (Fig-
country of origin. As a result, comparisons of survival between
ure S4, page 31).
racial/ethnic groups should be interpreted with caution.

Data limitations
The data presented in this report have several limitations and Second, much of the demographic information in health records,
should be interpreted with caution. First, data are limited for racial such as place of birth and racial/ethnic identity, is often incorrect
and ethnic subpopulations, so many statistics are presented for or incomplete for minority patients. This can occur when infor-
Asian Americans, Native Hawaiians, and Pacific Islanders in aggre- mation is assigned by a health care worker instead of obtained
gate, masking important differences within this heterogeneous directly from the patient or their family. The resulting misclas-
group. For example, cancer risk factor data are only available for sification leads to inaccurate, often underestimated cancer rates.
the three largest AANHPI subgroups (Chinese, Filipino, and Asian Similarly, it has been shown that a small percentage of decedents
Indian) because estimates for other groups are unreliable due to who had self-reported as AANHPIs were not recorded as such on
insufficient representation in national population-based surveys; death certificates. The standard US death certificate was revised in
questionnaires only in English or limited Asian languages may 2003 to include several AANHPI subgroups and had been adopted
also exclude some Asian Americans. NHPIs in particular have very by 44 states in 2012. This change will improve the availability of
distinct cancer risk profiles that are obscured when combined with disaggregated death data for AANHPIs, although issues of mis-
Asian Americans. Increasing recognition of the need to improve classification will likely persist.
health information for AANHPIs led the US Department of Health Third, there are challenges when calculating statistics for racial/
& Human Services to develop new standards for collecting data ethnic subgroups, especially those that are rapidly growing and
on race and ethnicity that will allow for more data reporting for changing. For example, population size, which is necessary for
the largest AANHPI subgroups in the future. In addition, data from computing rates, is often difficult to estimate. Also, rates for sub-
the first NHPI National Health Interview Survey are forthcoming. populations that are based on small numbers may be unreliable.
For information on data sources and methodology, please see
Sources of Statistics on page 64.
Major cancer sites increased by 1.1% annually.9 Reasons for this increase are thought
to include changes in factors such as body weight and repro
Female breast ductive patterns following immigration and acculturation.12, 16
Breast cancer is the most commonly diagnosed cancer and the Recent uptake of mammography screening among Asian Amer-
second leading cause of cancer death among AANHPI women, icans may also have contributed.12, 17, 18 Increases in incidence of
with a total of 11,090 new invasive cases and 1,180 deaths in situ breast cancers among AANHPIs since 1992 are consis-
expected to occur in 2016 (Figure S2, page 29). About one in 10 tent with increased screening.19 Breast cancer mortality rates
AANHPI women will be diagnosed with breast cancer in her life- decreased by 1.4% annually from 2003 to 2012 among AANHPI
time (Table S3, page 29). Age-standardized breast cancer women and by 1.9% annually among NHWs.10 These reductions
incidence and mortality rates are 30% and 50% lower, respec- have been attributed to improvements in both treatment and
tively, than those in NHWs (Figure S3, page 30). There is early detection.20
substantial variation in breast cancer occurrence within the
The stage at breast cancer diagnosis is similar in AANHPIs and
AANHPI population, with lower rates among groups that have
NHWs (Figure S8, page 34), although the overall 5-year cause-
immigrated more recently. Incidence rates range from 35.0 (per
specific survival is slightly higher among AANHPI women
100,000) in Cambodian women to 135.9 in Native Hawaiian
(Figure S6, page 33). However, there are some notable differ-
women (Figure S4, page 31). These differences are thought to
ences in survival by nativity and between AANHPI subgroups. A
be related to extent of adoption of western behaviors that
study in California showed that compared with foreign-born
increase breast cancer risk, such as a later age at childbirth,
women, those who are US-born are more likely to be diagnosed
fewer births, and higher body weight.12 A California study found
with breast cancer at a localized stage and have higher survival
breast cancer rates to be generally higher among US-born com-
after adjusting for stage and other prognostic factors.21 Com-
pared to foreign-born Asian American women.13 Breast cancer
pared to NHWs, survival rates are higher in Japanese but lower
incidence rates in AANHPI countries of origin are generally sub-
in NHPIs.22 Factors thought to contribute to the Japanese sur-
stantially lower than in the US;14 however, in many Asian
vival advantage include lower body weight and healthy diet.22, 23
countries, risk among recent generations is approaching that in
Differences in survival between Asian American subgroups may
the US.15
also reflect biological differences in tumor characteristics;24 a
Breast cancer incidence rates among AANHPI women have been study in California showed differing prevalence of breast cancer
increasing gradually since 2005 (Figure S7, page 33). From 2003 subtypes, each with distinct treatment needs and prognosis,
to 2012, in contrast to stable rates in NHWs, rates in AANHPIs among Asian American subgroups.25

Table S2. Leading Causes of Death among AANHPIs and NHWs, US, 2012
Asian American, Native Hawaiian,
and Pacific Islander Non-Hispanic white
Percent Percent
Number of total Death Number of total Death
Rank of deaths deaths rate Rank of deaths deaths rate
Cancer 1 15,340 27.2 104.2 2 462,499 22.9 170.2
Heart diseases 2 12,266 21.8 92.0 1 481,991 23.9 171.2
Cerebrovascular diseases 3 4,108 7.3 30.8 4 100,154 5.0 35.5
Accidents (unintentional injuries) 4 2,372 4.2 15.0 5 99,288 4.9 43.7
Diabetes 5 2,158 3.8 15.7 7 50,443 2.5 18.5
Influenza and pneumonia 6 1,745 3.1 13.9 8 40,460 2.0 14.3
Chronic lower respiratory diseases 7 1,624 2.9 12.8 3 127,116 6.3 46.2
Alzheimer's disease 8 1,379 2.4 11.6 6 72,772 3.6 24.9
Suicide 9 1,152 2.0 6.2 9 33,727 1.7 15.7
Nephritis, nephrotic syndrome & nephrosis 10 1,054 1.9 8.0 10 33,105 1.6 11.8
All causes 56,352 100.0 406.1 2,016,896 100.0 742.3
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. NHW = Non-Hispanic white. Rates are per 100,000 and age-adjusted to the 2000 US standard population.
Source: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2015.
Lung and bronchus S9, page 35).19 From 2003 to 2012, incidence and death rates
Among AANHPIs, an estimated 3,460 men and 3,030 women decreased in men by about 2% annually among AANHPIs and by
will be diagnosed with lung cancer in 2016 (Figure S2). Lung about 2.5% annually among NHWs.9, 10 Among AANHPI women,
cancer is the leading cause of cancer death among both men and incidence rates were stable while death rates declined by 0.5%
women. Although incidence and mortality are roughly half that per year; in contrast, among NHW women, incidence and death
among NHWs, risk varies substantially by subgroup (Figure S3, rates decreased by about 1% annually.9, 10
page 30). The highest lung cancer incidence rate in men is in AANHPIs are more likely than NHWs to be diagnosed with lung
Samoans (98.9 per 100,000), followed by Native Hawaiians (72.1) cancer at a distant stage of disease (58% versus 52%; Figure S8,
and Vietnamese (62.7), while Asians Indians/Pakistanis have page 34); however, five-year cause-specific survival is similar
the lowest rate (21.1) (Figure S4, page 31). The highest rate in (Figure S6, page 33). AANHPIs and NHWs are equally likely to
AANHPI women is in Native Hawaiians (44.0), followed closely receive appropriate treatment for lung cancer.32 The reasons for
by Samoans (41.8), with the lowest rate also in Asian Indians/ the roughly equivalent survival in AANHPIs given later stage at
Pakistanis (10.2). diagnosis are unknown, but may include genetic and/or cultural
In the US, smoking causes 83% and 76% of all lung cancer deaths factors32 or loss of patient contact.
among men and women, respectively.26 Data on historical trends
Colon and rectum
in smoking prevalence for AANHPIs are scarce. A survey of
smoking status in 20022005 found that 42% and 27% of NHPI Among AANHPIs, an estimated 2,990 men and 2,720 women
men and women, respectively, were current smokers compared will be diagnosed with colorectal cancer in 2016 (Figure S2). It is
to 21% and 4% of Indian/Pakistani men women.27 Notably, lung the third leading cause of cancer death among both AANHPI
cancer rates among Chinese women in both Asia and the US are men and women. Incidence and death rates are 20% lower and
relatively high given the low prevalence of smoking in this group. 30% lower, respectively, compared to NHWs (Figure S3, page 30).
This may be attributable to exposure to cooking oils at high However, within AANHPI subgroups, colorectal cancer incidence
heat, secondhand smoke, genetic susceptibility, or other rates are about three times higher in Japanese than in Asian
unknown risk factors.28-31 Indians/Pakistanis (Figure S4, page 31). Higher incidence rates
among US-born compared to foreign-born Chinese and Filipi-
Since the early 1990s, when data became available, lung cancer nos in a California study are likely due to a higher prevalence of
occurrence has been decreasing among AANHPI men and behaviors associated with colorectal cancer risk, such as
relatively stable among women (Figure S7, page 33, and Figure unhealthy diet, physical inactivity, and smoking.33

Figure S2. Leading Sites of New Cancer Cases and Deaths among AANHPIs 2016 Estimates

Male Female Male Female
Prostate Breast Lung & bronchus Lung & bronchus
4,550 (18%) 11,090 (34%) 2,290 (27%) 1,780 (21%)
Lung & bronchus Thyroid Liver & intrahepatic bile duct Breast
3,460 (14%) 3,320 (10%) 1,140 (14%) 1,180 (14%)
Colon & rectum Lung & bronchus Colon & rectum Colon & rectum
2,990 (12%) 3,030 (9%) 900 (11%) 900 (11%)
Liver & intrahepatic bile duct Colon & rectum Pancreas Pancreas
1,760 (7%) 2,720 (8%) 640 (8%) 740 (9%)
Non-Hodgkin lymphoma Uterine corpus Prostate Liver & intrahepatic bile duct
1,460 (6%) 2,380 (7%) 520 (6%) 570 (7%)
Urinary bladder Non-Hodgkin lymphoma Stomach Ovary
1,180 (5%) 1,170 (4%) 480 (6%) 500 (6%)
Kidney & renal pelvis Pancreas Leukemia Stomach
1,080 (4%) 1,010 (3%) 380 (5%) 400 (5%)
Oral cavity & pharynx Ovary Non-Hodgkin lymphoma Uterine corpus
1,000 (4%) 1,010 (3%) 320 (4%) 350 (4%)
Stomach Liver & intrahepatic bile duct Kidney & renal pelvis Leukemia
980 (4%) 830 (3%) 230 (3%) 320 (4%)
Leukemia Stomach Oral cavity & pharynx Non-Hodgkin lymphoma
980 (4%) 820 (2%) 220 (3%) 290 (3%)
All sites All sites All sites All sites
24,780 (100%) 32,960 (100%) 8,440 (100%) 8,470 (100%)
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. Estimates are rounded to the nearest 10, and cases exclude basal cell and squamous cell skin cancers and
in situ carcinoma except urinary bladder.
Table S3. Probability (%) of Developing Invasive Cancer among AANHPIs during Selected Age Intervals by Sex,
US, 2010-2012*
Birth to 49 50 to 59 60 to 69 70 and older Birth to death
All sites Male 2.2 (1 in 46) 3.8 (1 in 26) 9.0 (1 in 11) 29.2 (1 in 3) 36.2 (1 in 3)
Breast Female 1.8 (1 in 56) 2.0 (1 in 50) 2.7 (1 in 37) 4.7 (1 in 21) 10.3 (1 in 10)
Colon & rectum Male 0.3 (1 in 347) 0.6 (1 in 159) 1.2 (1 in 86) 3.9 (1 in 25) 5.3 (1 in 19)
Liver & intrahepatic bile duct Male 0.2 (1 in 644) 0.4 (1 in 249) 0.6 (1 in 157) 1.7 (1 in 59) 2.6 (1 in 39)
Female <0.1 (1 in 2,828) 0.1 (1 in 1,152) 0.2 (1 in 431) 1.0 (1 in 96) 1.3 (1 in 78)
Lung & bronchus Male 0.1 (1 in 789) 0.4 (1 in 229) 1.3 (1 in 78) 6.0 (1 in 17) 6.8 (1 in 15)
Prostate Male 0.1 (1 in 1,086) 0.8 (1 in 122) 3.0 (1 in 33) 7.0 (1 in 14) 9.4 (1 in 11)
Stomach Male 0.1 (1 in 1,411) 0.2 (1 in 640) 0.4 (1 in 273) 1.8 (1 in 57) 2.1 (1 in 49)
Female 0.1 (1 in 1,500) 0.1 (1 in 1,155) 0.2 (1 in 491) 1.2 (1 in 84) 1.4 (1 in 70)
Thyroid Male 0.2 (1 in 605) 0.1 (1 in 878) 0.2 (1 in 683) 0.2 (1 in 420) 0.6 (1 in 163)
Uterine cervix Female 0.2 (1 in 537) 0.1 (1 in 917) 0.1 (1 in 901) 0.3 (1 in 372) 0.6 (1 in 156)
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. *For those free of cancer at beginning of each age interval. All sites excludes basal and squamous cell
skin cancers and in situ cancers except urinary bladder.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.7.3. Statistical Research and Applications Branch, National Cancer Institute, 2015.
http://surveillance.cancer.gov/devcan.

among Japanese was primarily due to sociodemographic fac-
Figure S3. Rate Ratios Comparing AANHPIs tors, but also reflected specific disease characteristics.37
(numerator) with NHWs (denominator), 2008-2012
Prostate
Males
6 5.8 5.9 Incidence Prostate cancer is the most commonly diagnosed cancer and the
5
Mortality
fifth-leading cause of cancer death among AANHPI men, with
4,550 new cases and 520 deaths estimated in 2016 (Figure S2,
4
page 29). Incidence and mortality rates are 50% lower in
Rate Ratio
3 AANHPIs than in NHWs (Figure S3). However, incidence rates

2.2 2.2 vary by three-fold among subgroups, with rates of about 30 per
2 1.9 1.9
100,000 among Cambodians and Laotians compared to 100 or
1 0.8
1.0
0.8
more among Japanese, Filipinos, Native Hawaiians, and Samo-
0.7 0.6 0.6
0.5 0.5
ans (Figure S4).
0
Naso- Stomach Liver* Thyroid Colon & Lung and Prostate Prostate cancer incidence rates peaked among AANHPIs in the
pharynx rectum bronchus
early 1990s, followed by a steady decline (Figure S7, page 33).
This peak is largely due to the rapid uptake of prostate-specific
Females
6 6.0
antigen (PSA) testing.38 Prostate cancer death rates have been
generally declining among AANHPIs since 1993 (Figure S9, page
5
4.6 35), similar to NHWs. These declines are attributed to early
4 detection and improvements in treatment, although the relative
Rate Ratio
contribution of each is debated.39, 40

3
2.6 2.5
2.4
2 2.0 NHW men are more likely to be diagnosed with prostate cancer
1.7
at the localized stage than AANHPI men (79% versus 74%; Fig-
1 0.9 0.9 0.9 0.8 0.7 0.7 ure S8, page 34), but 5-year cause-specific survival is roughly
0.5 0.5 0.4
0
the same in both groups (Figure S6 page 33).
Naso- Stomach Liver* Thyroid Uterine Colon & Breast Lung &
pharynx cervix rectum bronchus
AANHPI = Asian American, Native Hawaiian, and Pacific Islander.

Cancer sites with higher rates
NHW = Non-Hispanic white. *Includes intrahepatic bile duct. among AANHPIs
Sources: Incidence NAACCR, 2015. Mortality National Center for Health
Statistics, Centers for Disease Control and Prevention, 2015. While AANHPIs generally have lower cancer rates than NHWs
American Cancer Society, Inc., Surveillance Research, 2016 overall and for the most common cancers, they are at higher risk
for stomach, liver, cervical (some subgroups), and nasopharyn-
geal cancers, which are associated with infections. The percentage
From 2003 to 2012, colorectal cancer incidence rates decreased of cancers attributable to infection in Asia ranges from 17% in
by 2.6% annually among AANHPI males and females, slightly central Asia to 26% in China, compared to 4% in North America.41
lower than declines of 3.8% and 3.2% among NHW males and The risk of infection-related cancers among AANHPIs in the US is
females, respectively (Figure S7, page 33).9 Mortality rates particularly high among first-generation immigrants.42 In addi-
declined during this time period in AANHPIs by 1.1% and 1.3% tion to infection-related cancers, some AANHPI subgroups have
annually in men and women, respectively.10 Long-term declines a higher risk of thyroid cancer.
in incidence and death rates are attributed to changing patterns
in risk factors, the uptake of screening, and improved treat- Stomach
ments.34, 35 However, the aggregation of AANHPIs likely masks Stomach cancer incidence and death rates are about twice as
differences in trends by subgroup. For example, a California high in AANHPIs as in NHWs (Figure S3). Among AANHPIs, an
study documented increasing colorectal cancer incidence rates estimated 980 men and 820 women will be diagnosed with stom-
in Koreans, Filipinos, and South Asians between 1988 and 2007.36 ach cancer in 2016 (Figure S2, page 29). Incidence is particularly
AANHPIs have slightly higher 5-year colorectal cancer-specific high among Koreans, with rates of 38.5 per 100,000 among males
survival rates than NHWs (Figure S6, page 33). However, one and 22.3 among females, roughly twice as high as those among
study found differences in outcomes between subgroups, with Japanese, who have the second highest rates (Figure S4). Stomach
the highest survival among Japanese and Asian Indians/Paki- cancer rates in Korea are the highest in the world for both males
stanis, while rates in other groups were similar to those in and females.14
NHWs.32 Another study found that the survival advantage

Rate per 100,000 population Rate per 100,000 population Rate per 100,000 population Rate per 100,000 population
As Ch As Ch As Ch As Ch
0
5
10
15
20
25
30
0
100
200
300
400
500
0
10
20
30
40
50
60
70
80
0
100
200
300
400
500
600
ia in ia in ia in ia in
n es n es n es n es
In e In e In e In e
di di di di
a n F ili p 7.8 a n F ili p 247.7 a n F ili p 21.7 a n F ili p 291.3 Males
, P in , P in , P in , P in
ak o ak o ak o ak o
298.9 16.7 352.2
Females
V i is t a 5.4 V i is t a V i is t a V i is t a
et et et et
na ni na ni na ni na ni
m 3.4 m 212.0 m 6.5 m 216.8
es es es es
Ko e 17.0 Ko e 257.3 Ko e 51.9 Ko e 318.6
r r r r
Ja ean Ja ean Ja ean Ja ean
pa 11.7 pa 264.1 pa 26.0 pa 313.9
Ca ne Ca ne Ca ne Ca ne
m se m se m se m se
bo 7.5 bo bo 11.7 bo 384.1
Liver
Liver
di di 303.5 di di
a a a a
All Sites
All Sites
La n La n La n La n
o 20.8 o 223.3 o 39.9 o 276.8
H a t ia n H a t ia n H a t ia n H a t ia n
wa
ii
27.6 wa
ii
238.2 wa
ii
66.1 wa
ii
377.8
S a an S a an S a an S a an
m 4.2 m 386.5 m 18.4 m 423.8
oa oa oa oa
n n n n
NH NH 442.8 NH 33.6 NH 526.5
W W W W
3.0 444.6 9.1 554.1
0
5
10
15
20
25
0
30
60
90
120
150
0
10
20
30
40
50
0
50
100
150
200
n es n es n es n es
In e In e In e In e
di di di 13.8 di 66.4
a n F ili p 8.4 a n F ili p 74.4 a n F ili p a n F ili p
ak o ak o ak o ak o
V i st a i 4.9 V i st a i 100.2 V i st a i 7.4 V i st a i 101.8
et et et et
m 4.5 m 75.6 m 5.3 m 61.2
es es es es
Ko e 11.4 Ko e 61.4 Ko e 16.0 Ko e 45.3
r r r r
p 22.3 p 68.0 p 38.5 p 48.3
Ca ane Ca ane Ca ane C a ane
m se m se m se m se
bo 10.7 bo 105.4 bo 21.3 bo 99.9
di di di di
a a a a
Breast
La n La n La n La n
Prostate
29.1
Stomach
Stomach
o o 35.0 o o
wa
ii
wa
ii
41.7 wa
ii
wa
ii
32.3
m 6.1 m 135.9 m 14.0 m 101.8
oa oa oa oa
n n n n
NH NH 116.6 NH NH 169.1
W W W W
3.7 136.9 8.5 150.9
0
5
10
15
20
25
30
0
10
20
30
40
50
60
0
1
2
3
4
5
6
7
8
0
20
40
60
80
100
n es n es n es n es
In e In e In e In e
di di di di
a n F ili p 13.1 a n F ili p 27.6 a n F ili p 4.4 a n F ili p 46.8
ak o ak o ak o ak o
V i is t a 23.7 V i is t a 28.6 V i is t a 7.3 V i is t a 60.2
et et et et
m 12.6 m 10.2 m 3.2 m 21.1
es es es es
Ko e 16.3 Ko e 28.2 Ko e 3.9 Ko e 62.7
r r r r
pa 16.9 pa 25.2 pa 4.9 pa 41.9
Ca ne Ca ne Ca ne Ca ne
m se m se m se m se
bo 10.2 bo 28.5 bo 3.6 bo 50.9
di di di di
a a a a
Thyroid
Thyroid
La n La n La n La n 46.2
o 9.8 o 26.1 o o
Figure S4. Cancer Incidence Rates* by Sex and AANHPI Subgroup, 2006-2010
wa
ii
wa
ii
18.4 wa
ii
wa
ii
65.2
Lung & bronchus
Lung & bronchus
m 19.8 m 44.0 m 6.9 m 72.1
oa oa oa oa
n n n n
41.8 98.9
on <25 cases are omitted. Includes intrahepatic bile duct. Please note that cancer sites are presented on different scales.
NH NH NH NH
W W W W
21.0 55.8 7.4 71.2
As Ch As Ch As Ch
0
3
6
9
12
15
0
10
20
30
40
50
0
10
20
30
40
50
60
70
80
ia in ia in ia in
n es n es n es
In e In e In e
di di di 39.1
a n F ili p 4.5 a n F ili p 31.8 a n F ili p
, P in , P in , P in
ak o ak o ak o
V i is t a 7.0 V i is t a 29.2 V i is t a 44.6
et et et
na ni na ni na ni
m 4.2 m 15.1 m 19.3
es es es
Ko e 9.5 Ko e 30.7 Ko e 39.3
r r r
Ja ean Ja ean Ja ean
pa 7.5 pa 35.9 pa 47.8
Ca ne Ca ne Ca ne
m se m se m se
bo 5.8 bo 39.4 bo 62.2
di di di
a a a
La n La n La n 46.4
o 12.7 o 34.5 o
H a t ia n H a t ia n H a t ia n
Uterine cervix
wa wa 31.3 35.4
Colon & rectum
wa
Colon & rectum
Source: Surveillance, Epidemiology, and End Results (SEER) Program, SEER 11 registries plus Greater California and New Jersey, National Cancer Institute, 2013.
ii ii ii
S a an S a an S a an
m 6.7 m 31.6 m 52.5
oa oa oa
n n n
NH NH 27.3 NH 34.4
W W W
6.8 38.8 50.5
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. NHW = Non-Hispanic white. Rates are age adjusted to the 2000 US standard population. *Rates based

Figure S5. Trends in Incidence and Mortality Rates for All Cancers Combined among NHWs and AANHPIs, 1990-2012
Asian Americans, Native Hawaiians, Non-Hispanic whites

and Pacific Islanders
700 700
Male incidence
600 600
500 500
Rate per 100,000
Male incidence Female incidence

400 400
300 300
Female incidence Male mortality
200 200
Male mortality
Female mortality
100 100
Female mortality
0 0
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Year Year
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. NHW = Non-Hispanic white. Rates are age adjusted to the 2000 US standard population.
Sources: Incidence- Surveillance, Epidemiology, and End Results (SEER) Program, SEER 13 registries, National Cancer Institute, 2015. Mortality- US Mortality Data, National
Center for Health Statistics, Centers for Disease Control and Prevention, 2015.
The bacterium Helicobacter pylori (H. pylori) is the strongest risk Liver
factor for stomach cancer, accounting for the majority of cases Liver cancer is one of the most fatal cancers, and incidence and
worldwide.43, 44 Other risk factors are thought to include dietary death rates among AANHPIs are about twice as high as those in
patterns, food storage and preservation practices, and low con- NHWs (Figure S3, page 30). Among AANHPIs, an estimated
sumption of fresh produce.45 Stomach cancer rates have been 1,760 men and 830 women will be diagnosed with liver cancer in
declining in the US since the early 20th century, and have also 2016 (Figure S2, page 29). It is the second-leading cause of can-
been declining more recently in Asian countries with histori- cer death among AANHPI men and the fifth-leading cause of
cally high rates, such as Japan, Korea, and China.46 These cancer death among AANHPI women. Liver cancer rates are
declines are thought to be due to improved availability of fresh particularly elevated in Laotians, Vietnamese, and Cambodians,
fruits and vegetables, lower consumption of salt-preserved likely due to a high prevalence of hepatitis B virus (HBV) infec-
foods, and reduced prevalence of H. pylori infection through tion in their country of origin and more recent immigration
improved sanitation and antibiotic treatment.47 Decreases in (Figure S4, page 31).28, 50
smoking may have also contributed to the declines.48 Stomach
cancer rates have been steadily declining among AANHPIs Chronic infection with HBV or hepatitis C virus (HCV) is the
(Figure S7, and Figure S9, page 35), with annual decreases strongest risk factor for hepatocellular carcinoma, the most
during 2003 to 2012 of about 3% to 4% for both incidence and common type of liver cancer.51 Other risk factors in Asian and
mortality.9, 10 Pacific Island nations include certain toxins and parasitic infec-
tions.52 Risk factors more common in developed countries
AANHPIs are more likely than NHWs to be diagnosed with include obesity, diabetes, alcoholic liver disease, and tobacco
stomach cancer at a localized or regional stage (Figure S8, page smoking. Risk factor prevalence varies both between and within
34), possibly because of awareness of the higher risk among AANHPI subgroups. For example, a study of Asian immigrants
Asian Americans and/or recommendations by some medical in New York City found that those born in Fujian Province,
societies for screening among Asian immigrants.49 Likely due to China, were more likely to have HBV infection than those born
earlier diagnosis, AANHPIs have higher 5-year survival than in other Chinese provinces.53
NHWs, 40% versus 28% in males and 38% versus 34% in females
(Figure S6).

Thyroid
Figure S6. Five-year Cause-specific Survival (%) Thyroid cancer is estimated to be the second most frequently
by Sex and Site for AANHPIs and NHWs, 2005-2011
diagnosed cancer among AANHPI females in 2016, with 3,320
Males new cases diagnosed (Figure S2, page 29). However, it is not a
100 95 94 94 94
leading cause of cancer death because survival is very high (Fig-
NHW
80
AANHPI
ure S6). The high ranking of thyroid cancer among AANHPIs is
68 70
66 66
60
62 59 driven by elevated rates among Filipinos, the second largest
Percent
AANHPI population, and the relatively low rates of most other

40
40
28 27
cancers. Incidence rates per 100,000 among Filipino women are
20
20 18 18 23.7 compared with 21.0 among NHW women (Figure S4, page
31). Thyroid cancer incidence rates in AANHPIs as a group
0
All sites Thyroid Prostate Colon & Naso- Stomach Liver* Lung & are slightly lower than those in NHWs, although mortality rates
rectum pharynx bronchus
are slightly higher among females, 0.8 per 100,000 versus 0.5
Females (Figure S3, page 30). AANHPIs are less likely than NHWs to be
100 98 97
89 92 diagnosed with thyroid cancer at a localized stage, 60% versus
80
70 70 72
74 69% (Figure S8, page 34), despite a similar 5-year survival rate
68 65 68
60 58 of about 95% (Figure S6). The reasons for the elevated rates in
Percent
38
Filipinos are not well understood, but are thought to include
40 34
26 25
dietary or environmental factors.57
23
20
20
0
All sites Thyroid Breast Uterine
cervix
Colon &
rectum
Naso-
pharynx
Stomach Liver* Lung &
bronchus
Figure S7. Trends in Cancer Incidence Rates among
AANHPIs by Site and Sex, 1992-2012
AANHPI = Asian American, Native Hawaiian, and Pacific Islander. Males
NHW = Non-Hispanic white. *Includes intrahepatic bile duct. 140
Source: Surveillance, Epidemiology, and End Results (SEER) Program, Prostate
SEER 18 registries, National Cancer Institute, 2015. 120
100
Rate per 100,000
80
Liver cancer is one of the few cancers for which incidence and 60
Lung & bronchus
mortality trends differ in AANHPIs and NHWs. While it is

40 Colon & rectum
among the most rapidly increasing cancers among NHWs, inci- Stomach
Liver*
dence rates among both male and female AANHPIs have been 20
Thyroid
stable since the early 1990s (Figure S7).19 Moreover, death rates 0
increased among NHWs by 2.9% and 2.1% per year in men and 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Year
women, respectively, from 2003 to 2012, in contrast to down-
Females
ward trends among AANHPI men (0.9% annually) and stable 140
trends in AANHPI women.10 The increasing rates among NHWs
120
are thought to be due to increased prevalence of chronic infec-
Breast
tion with HCV as a result of exposure to contaminated blood or 100
Rate per 100,000
medical equipment and injection drug use during the 1960s and 80
1970s, and possibly increases in obesity and type 2 diabetes
60
more recently.54 Cultural awareness of HBV screening and treat- Lung & bronchus
Colon & rectum
ment among AANHPIs, who have historically had the highest 40
liver cancer rates in the US, may be driving the declining mortal- Thyroid
20 Stomach Liver*
ity rates.54
0
AANHPIs are more likely than NHWs to be diagnosed with liver 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Year
cancer at a localized stage (46% versus 42%; Figure S8, page
Rates are age adjusted to the 2000 US standard population. *Includes
34) and also have higher five-year survival rates (Figure S6). intrahepatic bile duct.
Better survival among AANHPIs may be due to earlier stage at Source: Surveillance, Epidemiology, and End Results (SEER) Program, SEER 13
diagnosis, differences in receipt of treatment, and/or other registries, National Cancer Institute, 2015.
underlying risk factors, such as cirrhosis.55, 56

Figure S8. Age-adjusted Stage Distribution for Selected Cancers among AANHPIs and NHWs, 2008-2012
Localized Regional Distant Unknown/unstaged
100 2% 2% 2% 2%
4% 3% 5% 5% 5% 6% 6% 7%
7% 6% 5% 5%
5% 14% 13% 12% 11%
6% 13% 13%
12% 19% 19%
26%
80 12% 29% 29% 16%
33% 18% 28%
34%
32% 52%
58%
39%
60 26% 35% 36%
26%
Percent
31%
40 79% 26%
74%
69% 65%
64% 22%
60%
51% 19%
43% 42% 46%
20 40% 40%
29% 30%
19%
16%
0
NHW AANHPI NHW AANHPI NHW AANHPI NHW AANHPI NHW AANHPI NHW AANHPI NHW AANHPI NHW AANHPI
Prostate Thyroid Female Uterine Liver* Colon & Stomach Lung &
breast cervix rectum bronchus
AANHPI = Asian Americans, Native Hawaiians, and Pacific Islanders. NHW = Non-Hispanic whites. Based on rates age adjusted to the 2000 US standard population.
*Includes intrahepatic bile duct.
Source: Surveillance, Epidemiology, and End Results (SEER) Program, SEER 18 registries, National Cancer Institute, 2015.
Thyroid cancer incidence rates have been increasing by more second half of the 20th century, including those since 1990
than 5% annually over the past 10 years of data among both among Vietnamese, Cambodian, and Laotian women, are attrib-
AANHPIs and NHWs (Figure S7, page 33).9 The increasing uted primarily to increased screening.65
incidence is thought to be partially due to increased detection
Incidence and death rates among AANHPIs decreased by about
because of more sensitive diagnostic procedures and increased
3% annually during the past 10 years of data, while incidence
use of imaging, although incidental detection of thyroid tumors
rates decreased slightly and mortality rates remained stable in
is unlikely to completely account for these trends.58, 59 Increases
NHW women.9, 10 AANHPI women are less likely than NHW
across demographic and socioeconomic groups, as well as for
women to be diagnosed with cervical cancer at a localized stage
larger and later-stage tumors, also implicate environmental fac-
(43% versus 51%), although five-year survival is about 70% for
tors.60 Further research is needed to identify risk factors that
both groups (Figures S6, page 33, and S8).
may be causing these trends.
Nasopharynx
Uterine cervix
Nasopharyngeal carcinoma, which is the dominant form of
Cervical cancer incidence rates are higher in several AANHPI
nasopharyngeal cancer, is rare worldwide, although it has ele-
subgroups than in NHWs (Figure S4, page 31), despite being
vated incidence in certain regions and populations, including
lower overall (Figure S3, page 30). Incidence rates (per 100,000)
southern China and southeastern Asia.47 (The nasopharynx is
are twice as high in Cambodians (12.7) as in NHWs (6.8), and
the upper part of the throat, behind the nose.) Incidence rates
40% higher among Vietnamese women (9.5). In contrast, rates
among AANHPIs overall are about 5 to 6 times higher than
among Chinese (4.5) and Asian Indian/Pakistani (4.2) women
among NHWs (Figure S3, page 30), and are particularly ele-
are lower than those in NHWs.
vated for men in certain subpopulations, including Chinese,
Contemporary disparities in cervical cancer incidence world- Samoans, Guamanians/Chamorros, and Hmong.66-69 Nasopha-
wide are attributable to differences in the prevalence of both ryngeal carcinoma is thought to be caused by a combination of
human papillomavirus (HPV) infection, the cause of cervical viral, environmental, and genetic factors.70 It has been estimated
cancer, and screening.61-64 The Pap test has historically been the that about 98% of nasopharyngeal carcinoma cases worldwide
mainstay for screening in the US and can detect precancerous are related to infection with Epstein-Barr virus (EBV),47 although
lesions of the cervix that can be treated to prevent cancer. The only a small fraction of people who are infected with EBV
rapid declines in cervical cancer occurrence in the US over the develop the disease. Other environmental risk factors include

Prevalence of cancer risk factors
Figure S9. Trends in Cancer Mortality Rates among
AANHPIs by Site and Sex, 1990-2012 A large proportion of cancers are caused by known risk factors,
Males
such as tobacco use, excess body weight, and certain infectious
50
agents.77, 78 Prevalence of these risk factors within the AANHPI
population sheds light on the unique cancer burden in this
40 Lung & bronchus
group as a whole, as well as differences between subgroups.
Rate per 100,000
30 Tobacco
Smoking among AANHPIs varies by sex, nativity, acculturation,
20 and ethnicity. Overall, 10% of Asian Americans smoked in 2014,
Liver* Colon & rectum
compared with 19% of NHWs (Table S4, page 36). National

Stomach
10 smoking estimates are not available for NHPIs. In Hawaii, where
Prostate 55% of US Native Hawaiians reside, 27% of Native Hawaiians
0 report being current smokers.79 While similar percentages of
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
NHW men (20%) and women (18%) are current smokers, Asian
Year
25 Females American men (14%) are more than twice as likely to smoke as
Asian American women (6%). However, while US-born and for-
Lung & bronchus eign-born Asian American men are equally likely to be current
20
smokers, among women, the US-born are five times more likely
to smoke 16% versus 3% of the foreign-born. These sex differ-
Rate per 100,000
15
ences reflect smoking norms in home countries, where smoking
Breast
is more accepted among men than women, and acculturation in
10
Colon & rectum
the US.5 Among the three largest Asian American ethnic groups,
current smoking is more common among Filipinos (12%) than
5 Liver*
Chinese (7%) or Asian Indians (6%) (Table S4, page 36). A study
Stomach
of Asians in New York found smoking rates as high as 36% in
0 Korean men.80 Notably, while current smoking among NHWs is
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
most common among those with lower income and/or less edu-
Year
Rates are age adjusted to the 2000 US standard population. *Includes
cation and the same is true for Asian American men, the reverse
intrahepatic bile duct. is true for Asian American women.81
Source: US Mortality Data, National Center for Health Statistics, Centers for
Disease Control and Prevention, 2015. Smoking prevalence in Asian American men decreased from
25% in 1990-1992 to 14% in 2014, while in women, it has remained
stable at 6% (Figure S10, page 37). However, national trends do
not necessarily reflect those among specific groups or localities.
smoking, alcohol consumption, occupational exposures, and For instance, there was no decline in smoking among Asian
certain preserved foods.71 Cantonese salted fish, which is high in males in New York City from 2002 to 2010.82
nitrosamines, was identified as a risk factor for nasopharyngeal
carcinoma among southern Chinese in the 1970s,72 leading to its Overweight/obesity
designation by the International Agency for Research on Cancer Excess body weight increases the risk of several cancers, and
as a carcinogen.73 also contributes to the development of other cancer risk factors,
such as nonalcoholic fatty liver disease and type 2 diabetes.
Incidence and mortality rates for nasopharyngeal carcinoma in
Worldwide, normal weight is defined as a body mass index (BMI,
AANHPIs declined by about 2% to 3% annually from 2003 to
kg/m2) of 18.5-24.9, while overweight is 25-29.9 and obese is 30.
2012.9, 10 Rates have also been declining among some high-risk
However, it has been shown that Asians have a higher percent-
populations in Asia, possibly due to decreased smoking or con-
age of body fat than whites at the same BMI, as well as a higher
sumption of salted fish.74, 75 The recent declines among AANHPIs
risk for type 2 diabetes at a lower BMI.83 As a result, lower BMI
are not well understood, but may be attributable to dietary fac-
cutpoints established by the American Diabetes Association are
tors and decreased smoking.74 Five-year cause-specific survival
used for assessing diabetes risk in Asian Americans.84, 85 Diabe-
is higher for AANHPIs than NHWs (males 66% versus 59%;
tes is a risk factor for several cancers, including breast, liver,
females 74% versus 58%; Figure S6, page 33) for reasons that
pancreatic, and colorectal.86 While some studies report elevated
are unknown, but may include lower prevalence of other health
cancer risk at a lower BMI among Asians compared with other
conditions and/or less complete follow-up of AANHPI patients
populations, especially for colon cancer,87, 88 others do not.89, 90
after diagnosis.11, 76

Table S4. Prevalence of Cancer Risk Factors and Health Care Access by Sex and Asian Subgroup, US, 2014
Asian Asian subgroups* Non-Hispanic
white
Total Male Female Asian Indian Chinese Filipino
US Foreign US Foreign US Foreign
born born All born born All born born All Male Female All Male Female All Male Female All Male Female All
Cancer risk factors
Smoking (18+ years)
Current smoker 14.5 8.4 9.5 14.0 14.1 13.7 15.6 3.3 5.7 8.8 5.6 12.2 6.8 15.3 10.0 12.1 20.2 18.4 19.3
Former smoker 16.3 11.3 12.2 18.2 18.3 18.3 14.3 5.5 7.0 13.5 8.0 12.5 4.5 8.0 28.2 11.3 18.6 27.0 21.2 23.9
Never smoker 69.2 80.3 78.4 67.7 67.5 67.9 70.1 91.2 87.3 77.8 95.9 86.4 75.3 92.7 85.1 56.6 78.7 69.2 52.8 60.5 56.8
Alcohol (18+ years)
Moderate 15.6 7.3 8.9 20.6 12.0 13.7 10.4 3.3 4.8 10.1 6.0 6.1 5.5 5.7 16.4 4.7 9.8 25.6 11.5 18.3
Heavy 1.0 1.3 1.5 1.3 0.7 3.6 2.9 6.5 6.4 6.5
Body weight* (20+ years)
Overweight/obese
41.7 50.2 34.5 74.6 64.2 69.3
(BMI 25 kg/m2)
Overweight
29.1 37.6 22.1 39.9 26.0 32.9
(BMI = 25-29.9)
Obese (BMI 30) 12.6 12.6 12.4 34.7 38.2 36.4
Physical activity (18+ years)
No leisure time physical
25.9 28.8 28.8 22.8 24.6 25.5 29.0 32.7 31.7 24.9 30.9 27.9 23.3 27.2 25.7 25.1 32.7 29.5 25.2 27.2 26.3
activity
Met recommended levels
51.6 47.7 48.1 58.2 53.9 54.3 45.4 42.3 42.8 58.3 40.6 49.8 55.3 47.4 51.0 53.2 44.6 48.3 55.7 51.3 53.4
of aerobic activity
Health care access (18-64 years)
Uninsured 9.4 15.5 13.1 11.0 17.2 14.6 13.8 11.7 10.8 11.3 11.0 12.2 11.2 11.7 18.2 13.2 15.3 12.9 10.2 11.5
No regular source of
12.2 20.5 17.3 16.3 24.3 21.1 16.8 13.8 20.5 15.9 18.1 17.9 11.6 14.6 21.1 13.4 16.8 20.1 10.6 15.3
medical care
BMI = Body mass index. *Estimates from 2013-2014 data combined. Moderate: 12+ drinks in lifetime and (male) 3-14 drinks/week in past year or (female) 3-7 drinks/
week in past year. Heavy: 12+ drinks in lifetime and (male) >14 drinks/week in past year or (female) >7 drinks/week in past year. Aerobic activity recommendations:
includes 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity each week. Estimate not provided due to instability. Note: Percentages
are age adjusted to the 2000 U.S. standard population.
Sources: All risk factors except BMI National Center for Health Statistics. National Health Interview Survey, 2013 and 2014. Public-use data file. BMI National Center
for Health Statistics. National Health and Nutrition Examination Survey Data, 2013-14.
Three large pooled studies did not find Asians to be at higher Alcohol
risk for cancer death at a lower BMI.91-93 Thus, evidence to date is Alcohol consumption is associated with increased risk of several
inconclusive about whether cancer risk is increased in Asians at cancers, and it also may interact with HBV and HCV to further
a lower BMI. promote the development of liver cancer.97 This is of special con-
Asian Americans are much more likely to be a healthy weight cern among Asian Americans, who bear a disproportionate
than NHWs.94 About 42% of Asian Americans are overweight or burden of HBV infection. Asian Americans are half as likely as
obese compared to 69% of NHWs (Table S4). In contrast, three- NHWs to be moderate drinkers; however, prevalence among US-
quarters of Native Hawaiians in Hawaii are overweight or born Asian Americans (16%) approaches that of NHWs (18%)
obese.79 Asian American men (50%) are more likely to be over- (Table S4).
weight or obese than Asian American women (35%). Excess body
weight has increased among US-born Asian Americans, as well
Infectious agents
as recent and long-term immigrants. For instance, the preva- H. pylori
lence of overweight among US-born Filipinos increased from Chronic infection with H. pylori is highly endemic in Asia and
36% in 1992-1995 to 55% in 2003-2008.95 Prevalence of over- prevalence patterns mirror gastric cancer risk.98 H. pylori sero
weight and obesity varies by Asian American subgroup; a study prevalence is close to 60% in China and Korea,98 whereas it is
in California found that only 8% of South Asian and 9% of Chi- about 30% in the United States, where H. pylori infection has been
nese children were overweight, compared to 16% of Japanese declining since the late 19th century.99, 100 Although the spread of
and Korean children and 18% of Filipino children.96 H. pylori is not well understood, infection occurs primarily dur-
ing childhood and risk is higher in lower socioeconomic groups.100
Among Japanese immigrants to the US in the 1970s and 1980s,

the risk of stomach cancer was shown to be lower than Japanese
living in Japan, and risk was even lower among Japanese born in Figure S10. Trends in Current Smoking* among Asian
the US.101 Preliminary studies in Asia have shown that eradica- American Adults (18 Years and Older), 1990-2014
tion of H. pylori infection with antibiotics can reduce the risk of
stomach cancer.102 30
HBV and HCV 25

White men
HBV infection is highly endemic in Asia.103 As a result, Laos,
Vietnam, Korea, and China have among the highest liver cancer 20 White women
incidence in the world.14 Nearly 70% of AANHPIs living in the US
Percent
were born or have parents who were born in a country where 15
Asian men
HBV is highly prevalent.104 AANHPIs account for more than 50%
10
of those infected with HBV in the United States, although most
who harbor the virus are unaware.104 The HBV vaccine was Asian women
5
introduced in the early 1980s and has resulted in dramatic
declines in liver cancer incidence among vaccinated cohorts in
0
Taiwan.105 HBV vaccination in the US among AANHPI teens 1990-1992 1993-1995 1999-2001 2006-2008 2009-2011 2011-2013 2014
(86%) is slightly lower than other racial/ethnic groups, which all Year
have HBV vaccination coverage above 90%.106 The United States
Preventive Services Task Force (USPSTF) recommends screen- *Estimates are age adjusted to the 2000 US standard population.
Source: 1990-2013: Health, United States, 2014: With Special Feature on
ing all those born in regions with a prevalence of HBV infection Adults Aged 55-64.6 2014: Centers for Disease Control and Prevention.
2%, which includes all countries of Asia and the Pacific Islands National Health Interview Survey, 2014. Public-use data file.
except Australia and New Zealand.107 Among adults 18 years of American Cancer Society, Inc., Surveillance Research, 2016
age and older, about 28% of both Asian Americans and NHWs
had received a hepatitis B test (Table S5, page 38).
girls 13-17 years of age, 36% received the three recommended
While HBV is the leading liver cancer risk factor among Asian doses and 72% of those who received the first dose completed all
Americans in the US, HCV is also an important risk factor, espe- three doses, similar to uptake among NHWs (Table S5, page
cially in some groups.108-110 For example, HCV is more common 38). HPV vaccination uptake in Asian American boys is higher
than HBV in Japan, where about 65% of liver cancers are esti- than in NHWs, with 27% receiving the three recommended
mated to be attributable to HCV;111 however, HCV prevalence doses (compared with 19% in NHW boys) and 63% completion
there has been decreasing due to public health programs.112 HCV (compared with 58% in NHW boys) (Table S5, page 38). HPV
is also more prevalent in Pakistan and among older adults in vaccine uptake is influenced by caregiver awareness and varies
Taiwan.108 The USPSTF also recommends HCV screening for all by local context; in a study in Los Angeles, California, only 64%
adults born between 1945 and 1965, who account for three- and 44% of Chinese and Korean mothers, respectively, with age-
quarters of HCV-infected individuals and HCV-related deaths in eligible daughters were aware of the vaccine.117
the United States.113 HCV testing coverage in this cohort is 13%
among NHWs and 10% among Asian Americans (Table S5, page
38). Through testing, HBV and HCV can be detected and Prevalence of cancer screening
treated, reducing the risk of liver cancer.114 Cervical and colorectal screening can detect and remove pre-
cancerous lesions, thus preventing the development of cancer. In
HPV addition, screening for colorectal, cervical, and breast cancer
HPV causes nearly all cervical cancers in the US, as well as many can detect cancers at an earlier stage when more treatment
oropharyngeal and anogenital cancers.115 A clinic-based study options are available. Please see page 66 for screening recom-
in 2003-2005 found that 17% of AANHPI women had a high-risk mendations for people at average cancer risk.
HPV infection (the type most likely to cause cancer), compared
with 23% of white women.116 More recent HPV prevalence data Asian Americans are less likely than NHWs to be current for cer-
are not available for AANHPI in the US. Worldwide, it is esti- vical and colorectal cancer screening, but have similar rates of
mated that 5% of women in North America are infected with any breast cancer screening (Table S5). Seventy-one percent of Asian
type of HPV, compared with 11% of women in Eastern Asia, 7% in American women overall (21-65 years of age) reported having a
Southern Asia, and 14% in Southeastern Asia.61 Vaccines to pre- Pap test within the past 3 years, compared with 83% of NHWs.
vent infection with the most common cancer-causing types of However, prevalence varies widely by subgroup and in Filipinas
HPV have been available since 2006 and are recommended for is equal to that in NHWs. Slightly more than two-thirds of Asian
boys and girls at 11 to 12 years of age. Among Asian American American (68%) and NHW (69%) women 45 years of age or older

Table S5. Cancer Screening Test Use (%), Vaccination Coverage (%), and Hepatitis Testing (%) by Asian Subgroup,
US, 2013-2014
Asian* Asian Indian* Chinese* Filipino* NHW
All Uninsured All All All All Uninsured
Cervical cancer screening (women 21-65 years)
Pap test within past 3 years 70.9 54.9 69.6 65.8 83.0 82.8 57.3
Breast cancer screening (women 45+ years)
Mammogram within past 2 years 67.7 51.7 64.0 65.6 67.8 68.9 39.8
Colorectal cancer screening (50+ years)
Endoscopy/FOBT
Total 52.3 53.6 53.6 58.9 60.5 29.8
Men 59.0 55.3 72.4 60.4 21.3
Women 46.6 14.9 52.3 46.6 60.8 36.6
FOBT (past year)
Total 10.7 15.0 11.3 7.4 2.2
Men 9.7 7.6 2.1
Women 11.5 13.5 14.0 7.2
Endoscopy
Total 47.9 49.6 46.8 54.2 58.0 28.1
Men 54.6 47.6 66.8 57.8 19.8
Women 42.2 46.2 42.9 58.3 34.6
HPV vaccine utilization (13-17 years)
Girls
1 dose 54.9 56.1
3 doses 35.7 37.5
Completion rate# 71.7 70.6
Boys
1 dose 45.8 36.4
3 doses 26.6 18.8
Completion rate# 63.0 57.9
Hepatitis B testing** (18+ years)
Has received hepatitis B test 28.6 26.2 25.4 31.6 30.0 28.1 26.8
Hepatitis C testing** (48-69 years)
Has received hepatitis C test 10.4 7.6 11.3 13.8 12.6 12.4
NHW = Non-Hispanic white. *May be of any ethnicity. Among women with an intact uterus. Either a fecal occult blood test within the past year, sigmoidoscopy within
the past five years, or a colonoscopy within the past 10 years. Sigmoidoscopy in the past 5 years and/or colonoscopy in the past 10 years. Percentages for all Asians
exclude Hispanic ethnicity. Data are for 2014. #Percentage who completed the 3-dose vaccination series among those who had at least 1 dose. **Combined 2013 and
2014 NHIS data. The US Preventive Services Task Force recommends screening for adults born 1945-1965; these adults would be 48-69 years of age for the 2013-2014
available data. Estimate not provided due to instability. Note: Percentages for cancer screening hepatitis testing are age adjusted to the 2000 U.S. standard population.
Source: Cancer screening National Center for Health Statistics. National Health Interview Survey, 2013. Public-use data file. HPV vaccination Reagan-Steiner S, et al.111
Hepatitis testing National Center for Health Statistics. National Health Interview Survey, 2013 and 2014. Public-use data file.
report having a mammogram within the past two years. Only Asian Americans of lower socioeconomic status are less likely to
about half of Asian Americans (52%) 50 years of age and older receive recommended cancer screening, often because of less
received recommended colorectal cancer screening, compared access to health care.119 Among Asian Americans, 13% of adults
with 61% of NHWs. Notably, this disparity is almost entirely 18-64 years of age were uninsured in 2014, including 16% of those
driven by the low screening rate among Asian American women. who were foreign-born, while 21% of men and 14% of women had
While endoscopy is generally the preferred screening test among no regular source of medical care (Table S4, page 36). Among
both NHWs and Asian Americans, Asian Americans are more Native Hawaiians in Hawaii, 8% were uninsured and 16% had no
likely than NHWs to have had a fecal occult blood test (11% ver- regular source of medical care.79 Successful interventions to pro-
sus 7%) and less likely to have had endoscopy (48% versus 58%) mote cancer screening among Asian Americans utilize lay health
(Table S5). A recent study reported that Native Hawaiians were workers, one-on-one communications, translated materials, and
more than 30% less likely to get a colonoscopy or mammogram approaches that not only involve Asian community members,
compared to NHWs.118 but also health care providers.120 Patient navigators in particular
have been shown to improve the receipt of recommended screen-
ing and follow-up.121

Additional Resources Asian Pacific Islander Cancer Education
American Cancer Society Materials Tool
The American Cancer Society provides information and services The Asian Pacific Islander Cancer Education Materials (APICEM)
for AANHPIs, including: tool is a searchable web tool where users can access hundreds
of patient-focused cancer education materials in 22 Asian and
Cancer information in Asian languages: cancer.org/ Pacific Islander languages along with their English translations.
asianlanguagematerials The tool was created to help clinicians provide information
California Chinese Unit: acsccu.org to their Asian and Pacific Islander patients and is continually
updated by its contributors, which include cancer research
New York and New Jersey Asian initiatives: cancer.org/myacs/
organizations and AANHPI health advocacy and community
eastern/programsandservices/asian-initiatives
organizations. APICEM is made possible through the coop-
eration of the American Cancer Society; the Asian American
Asian American Network for Cancer Awareness, Network for Cancer Awareness, Research and Training; and the
Research, and Training National Cancer Institute.
aancart.org Visit cancer.org/apicem for more information.
The Asian American Network for Cancer Awareness, Research,
and Training (AANCART) aims to to reduce cancer health
disparities by conducting community-based participatory edu NHPIs by increasing access to prevention and healthcare; devel-
cation, training, and research by, for, and with Asian American oping and conduct evidence-based intervention research; and
community. training and developing researchers using community-based par-
ticipatory research (CBPR) methods to reduce health disparities.
Asian and Pacific Islander National Cancer
Survivors Network
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95. Singh GK, Siahpush M, Hiatt RA, Timsina LR. Dramatic increases
113. Centers for Disease Control and Prevention. CDC Recommenda-
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tions for Specific Populations and Settings: People Born 1945-1965 &
nic-immigrant and social class groups in the United States, 1976-2008. J
Hepatitis C. Available at: http://www.cdc.gov/hepatitis/populations/1945-1965.
Community Health. 2011;36:94-110.
htm . Accessed November 16, 2015.
96. Guerrero AD, Ponce NA, Chung PJ. Obesogenic Dietary Practices of
114. Lu T, Seto WK, Zhu RX, Lai CL, Yuen MF. Prevention of hepatocel-
Latino and Asian Subgroups of Children in California: An Analysis of
lular carcinoma in chronic viral hepatitis B and C infection. World J Gas-
the California Health Interview Survey, 2007-2012. Am J Public Health.
troenterol. 2013;19:8887-8894.
2015;105:e105-e112.
115. Human papillomavirus-associated cancers United States, 2004-
97. Boffetta P, Hashibe M. Alcohol and cancer. Lancet Oncol. 2006;7:149-
2008. MMWR Morb Mortal Wkly Rep. 2012;61:258-261.
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116. Datta SD, Koutsky LA, Ratelle S, et al. Human papillomavirus infec-
98. Fock KM, Ang TL. Epidemiology of Helicobacter pylori infection and
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gastric cancer in Asia. J Gastroenterol Hepatol. 2010;25:479-486.
United States, 2003-2005. Ann Intern Med. 2008;148:493-500.
99. Suerbaum S, Michetti P. Helicobacter pylori infection. New Engl J
117.Bastani R, Glenn BA, Tsui J, et al. Understanding suboptimal
Med. 2002;347:1175-1186.
human papillomavirus vaccine uptake among ethnic minority girls.
100. Everhart JE, Kruszon-Moran D, Perez-Perez GI, Tralka TS, McQuil- Cancer Epidemiol Biomarkers Prev. 2011;20:1463-1472.
lan G. Seroprevalence and ethnic differences in Helicobacter pylori
118. Harmon BE, Little MA, Woekel ED, et al. Ethnic differences and
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1363.
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101. Kamineni A, Williams MA, Schwartz SM, Cook LS, Weiss NS. The miol. 2014;38:162-167.
incidence of gastric carcinoma in Asian migrants to the United States
119. Ward E, Halpern M, Schrag N, et al. Association of insurance with
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102. Herrero R, Parsonnet J, Greenberg ER. Prevention of gastric cancer.
120. Hou SI, Sealy DA, Kabiru CW. Closing the disparity gap: cancer
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103.McGlynn KA, Petrick JL, London WT. Global Epidemiology of Asian Pac J Cancer Prev. 2011;12:3133-3139.
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121. Braun KL, Kagawa-Singer M, Holden AE, et al. Cancer patient navi-
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August 10, 2015.

Tobacco Use
Smoking remains the worlds most preventable cause of death. Based on the 2014 National Health Interview Survey (NHIS),
Since the first US Surgeon Generals report on smoking and approximately 40 million adults (18 years and older) were
health in 1964, there have been more than 20 million premature current smokers,7 about 4.5 million fewer than in 2004.8
deaths attributable to smoking in the US. Each year, cigarette The proportion of daily smokers reporting light or intermit-
smoking results in an estimated 480,000 premature deaths, tent smoking (fewer than 10 cigarettes per day) increased
42,000 of which are due to secondhand smoke exposure.1, 2 The between 2004 (17%) and 2014 (27%), whereas heavy smoking
number of people who die prematurely or suffer illness from (30 or more cigarettes per day) declined from 13% to 7%.7, 8
tobacco use impose substantial health-related economic costs
Although uptake of smoking began earlier in men than in
on society. In 2012, smoking accounted for $176 billion in health
women, the gender gap, particularly among non-Hispanic
care-related expenditures in the US.1
whites, has narrowed. As of 2014, there was a 2 percentage
point difference in smoking prevalence between white men
Cigarette Smoking (19%) and women (17%), a 9 percentage point difference
Cigarette smoking increases the risk of cancers of the oral cavity between non-Hispanic black men (23%) and women (14%), a
and pharynx, larynx, lung, esophagus, pancreas, uterine cervix, 7 percentage point difference between Hispanic men (15%)
kidney, bladder, stomach, colorectum, and liver, as well as acute and women (8%), and a 9 percentage point difference between
myeloid leukemia.1 In addition, the International Agency for Asian men (14%) and women (5%).7
Research on Cancer recently concluded that there is some evi- Smoking is most common, and has declined more slowly,
dence that tobacco smoking causes female breast cancer, and among those with the least education. In 2014, smoking
the Surgeon General concluded that smoking increases the risk prevalence was 23% among adults 25 years and older with
of advanced-stage prostate cancer.1,3 Excluding secondhand less than a high school diploma and 5% among those with
smoke, smoking is estimated to cause 32% of all cancer deaths in graduate degrees. Smoking was most prevalent among adults
the US,4 including 83% of lung cancer deaths among men and with a GED (General Educational Development), or high
76% of lung cancer deaths among women (Figure 4).5 school equivalency credential (43%).7
The prevalence of current cigarette smoking (defined as Among US states in 2013, the prevalence of adult smok-
smoking at least 100 cigarettes and currently smoking) ing ranged from 10% in Utah to 27% in West Virginia and
among adults 18 years of age and older has declined by more Kentucky.9
than half, from 42% in 1965 to 17% in 2014; however, reduc-
tions vary across population subgroups.6,7
Figure 4. Number and Percentage (%) of Cancer Deaths Attributable to Cigarette Smoking in 2011,
Adults 35 Years and Older
Attributable to cigarette smoking Other causes
Men Women
Lung, bronchus, & trachea 83% Lung, bronchus, & trachea 76%
Esophagus 52% Pancreas 14%
Urinary bladder 46% Colorectum 8%

Urinary Bladder 41%
Liver & intrahepatic bile duct 28%
Esophagus 44%
Colorectum 11%
Oral cavity & pharynx 43%
Oral cavity & pharynx 49%
Liver & intrahepatic bile duct 14%
Larynx 72%
Uterine cervix 22%
Kidney & renal pelvis 22%
Larynx 93%
Pancreas 10% Stomach 11%
Stomach 26% Kidney & renal pelvis 7%
Myeloid leukemia 23% Myeloid leukemia 3%
0 20 40 60 80 100 0 20 40 60 80 100
Number of deaths (in thousands) Number of deaths (in thousands)
Source: Siegel RL, et al.5

2015 American Medical Association. All rights reserved.

Although current cigarette smoking among US high school Nationwide, SHS exposure among nonsmokers declined from
students (at least once in the past 30 days) increased from 84% in 1988-199423 to 25% in 2011-2012,24 likely reflecting
28% in 1991 to 36% in 1997, it declined to 9% in 2014.10, 11 widespread implementation of smoke-free laws and reduc-
tion in smoking prevalence. However, this progress differs by
In contrast to the decline in cigarette smoking among teens,
subgroup, and poor individuals remain substantially more
current use of hookahs in this age group has increased
likely to be exposed than those who are more affluent.
dramatically, from 4% in 2011 to 9% in 2014, and is now as
common as smoking.11 In the US, as of July 1, 2015, 763 municipalities and 24 states,
the District of Columbia, Puerto Rico, and the US Virgin
Islands have laws in place requiring all non-hospitality work-
Cigar Smoking places, restaurants, and bars to be 100% smoke-free.25
Cigar smoking causes many of the same diseases as cigarette Currently, 49% of the US population is covered by a 100%
smoking and smokeless tobacco. Regular cigar smoking is asso- smoke-free policy in workplaces, restaurants, and bars.25
ciated with an increased risk of cancers of the lung, oral cavity,
larynx, esophagus, and probably pancreas.12 Cigar smokers have
4 to 10 times the risk of dying from lung, laryngeal, oral, or E-cigarettes
esophageal cancer compared to never smokers.13, 14 Historically, Electronic nicotine delivery systems (ENDS) are battery-oper-
lower tax rates on cigars have caused some smokers to switch ated devices that allow the user to inhale a vapor produced from
from cigarettes to less costly cigars. cartridges or tanks filled with a liquid typically containing nico-
tine, propylene glycol and/or vegetable glycerin, other chemicals,
While total cigarette consumption declined by one-third
and sometimes flavoring. The term e-cigarettes will be used
from 2000 to 2011, large cigar consumption more than
hereafter to refer to any ENDS, including those not designed to
tripled, from 3.9 billion (cigarette equivalents) to 12.9 billion.15
mimic cigarettes. Some studies have shown lower levels of toxic
According to the 2012-2013 National Adult Tobacco Survey chemicals in aerosol from e-cigarette products than in smoke
(NATS), 2% of adults (3% of men and <1% of women) reported from combustible cigarettes, and e-cigarettes are promoted as a
smoking cigars every day or some days.16 less harmful alternative to traditional cigarettes and a way to
Cigar use was highest among non-Hispanic blacks (4%) and bypass smoke-free laws. However, the long-term health risks of
those with household incomes <$20,000.16 using these products, or being exposed to them secondhand, are
In 2014, 8% of US high school students had smoked cigars, unknown and likely vary depending on the specific e-cigarette
cigarillos, or little cigars at least once in the past 30 days product and how it is used.
down from 18% in 1999.10, 11 While the health risks of e-cigarettes are not fully known, there
In contrast to non-Hispanic whites and Hispanics, cigars is growing concern that e-cigarette use will normalize cigarette
are the most common form of tobacco use among black high smoking and lead to the use of other forms of tobacco products
school students (9%, versus 5% to 6% for e-cigarettes, hookahs, with known health risks. Indeed, a recent study indicates that
and cigarettes).11 adolescent e-cigarette users are much more likely to initiate
cigarette, cigar, or hookah smoking than nonusers.26 Also, these
Secondhand Smoke products may discourage utilization of evidence-based cessa-
tion therapies among those who want to quit. E-cigarettes have
There is no safe level of exposure to secondhand smoke (SHS), or
been gaining in popularity, particularly among high school
environmental tobacco smoke, which contains more than 7,000
students.
chemicals, at least 69 of which cause cancer.17 Exposure to SHS
increases the risk of lung diseases, including lung cancer, coronary According to the 2012-2013 NATS, 2% of adults were current
artery disease, and heart attacks.18-20 SHS can also cause coughing, (every day or some days) e-cigarette users.16
wheezing, chest tightness, and reduced lung function in adult non- The prevalence of ever use of e-cigarettes among adults
smokers.21 Laws that prohibit smoking in public places and create doubled between 2010 and 2011, from 3% to 6%.27
smoke-free environments are the most effective approach to pre-
E-cigarette use (at least once in the past 30 days) has increased
vent exposure to and harm from SHS. In addition, there is strong
most rapidly among high school students, surpassing cigarette
evidence that smoke-free policies decrease the prevalence of both
smoking in 2014 to become the most common form of tobacco
adult and youth smoking.20, 22 Momentum to regulate public smok-
use; prevalence increased from 2% in 2011 to 13% in 2014.11
ing began to increase in 1990, and smoke-free laws have become
increasingly common and comprehensive over time. In high school students, e-cigarette use is more than twice as
high among non-Hispanic whites (15%) and Hispanics (15%)
Each year, about 7,330 nonsmoking adults die of lung cancer as among blacks (6%).11
as a result of breathing SHS.1

Smokeless Tobacco Products According to the 2014 NHIS, 57% (52.2 million) of the 92.3
million Americans who ever smoked at least 100 cigarettes
Smokeless tobacco products include moist snuff, chewing
are now former smokers.7
tobacco, snus (a spitless, moist powder tobacco pouch), dissolv-
able nicotine products, and a variety of other tobacco-containing In 2014, 49% of current smokers attempted to quit for at least
products that are not smoked. These products cause oral, esoph- one day in the past year.7
ageal, and pancreatic cancers; precancerous lesions of the mouth; Smokers with an undergraduate or graduate degree are more
gum recession; bone loss around the teeth; and tooth staining.28, 29 likely to succeed in quitting than less educated smokers.37
They can also lead to nicotine addiction. Compared to quitting Although effective cessation treatments can double or triple a
completely, switching to smokeless tobacco products as a substi- smokers chances of long-term abstinence, only 32% of people
tute for smoking has been shown to increase the risk of who try to quit used counseling or medication. Use of smok-
tobacco-related death.30 Furthermore, smokers who use smoke- ing cessation aids is particularly low among smokers with
less products as a supplemental source of nicotine to postpone or lower educational attainment.38
avoid quitting will increase rather than decrease their risk of
In 2013, 56% of high school students who were current ciga-
lung cancer.31
rette smokers tried to quit during the 12 months preceding
Recently, the smokeless market in high-income countries, the survey.39
including the US, has been consolidated from smaller tobacco
companies into the control of tobacco multinational corpora-
Reducing Tobacco Use and Exposure
tions. In the US, the sales of smokeless tobacco products are
growing at a more rapid pace than cigarettes.32 As part of their There are federal, state, and local initiatives aimed at reducing
marketing strategy, the industry is actively promoting these tobacco exposure. While states have been at the forefront of
products both for use in settings where smoking is prohibited tobacco control efforts, the importance of the federal govern-
and as a way to quit smoking. However, there is no evidence to ments role was emphasized in a 2007 Institute of Medicine
date that these products are as effective as proven cessation Report.40 Federal initiatives in tobacco control hold promise for
therapies for quitting. When smokeless tobacco was aggres- reducing tobacco use, and include regulation of tobacco prod-
sively marketed in the US in the 1970s and 1980s, use of these ucts, national legislation ensuring coverage of some clinical
products increased among adolescent males, but not among cessation services, and tax increases. The Family Smoking Pre-
older smokers trying to quit. The use of any smokeless tobacco vention and Tobacco Control Act of 2009 granted the US Food
product is not considered a safe substitute for quitting.33, 34 and Drug Administration (FDA) the authority to regulate the
manufacturing, selling, and marketing of tobacco products. Key
The sales of moist snuff increased by 66% between 2005 provisions that have already gone into effect include the prohibi-
and 2011.35 tion of misleading descriptors such as light, low, and mild on
According to the 2014 NHIS, 2% of adults 18 years of age and tobacco product labels and the prohibition of fruit and candy
older (4% of men and <1% of women) currently (every day or cigarette flavorings. Provisions in the 2010 Affordable Care Act
some days) used smokeless tobacco products.7 ensure at least minimum coverage of evidence-based cessation
According to the 2012-2013 NATS, whites and American Indi- treatments, including pharmacotherapy and cessation counsel-
ans/Alaska Natives were more likely to use smokeless tobacco ing, to previously uninsured tobacco users, pregnant Medicaid
than non-Hispanic black, Hispanics/Latinos, or Asians.15 recipients, and eligible Medicare recipients. Furthermore, cost-
sharing for evidence-based cessation treatments was eliminated
Current adult smokeless tobacco use (including snus use)
for new or renewed private health plans and Medicare recipients.
varied from <2% in California; Washington, DC; and Massa-
chusetts to 9% in West Virginia in 2013.9 In 2000, the US Surgeon General outlined the goals and compo-
According to the 2014 National Youth Tobacco Survey, 10% nents of comprehensive statewide tobacco control programs.41
of high school boys and 1% of girls used smokeless tobacco in These programs seek to prevent the initiation of tobacco use
the past 30 days.11 among youth, promote quitting at all ages, eliminate nonsmok-
ers exposure to SHS, and identify and eliminate the disparities
related to tobacco use and its effects among different population
Smoking Cessation groups. The Centers for Disease Control and Prevention (CDC)
Smokers who quit, regardless of age, increase their longevity, recommends funding levels for comprehensive tobacco use pre-
with those who quit before middle age generally experiencing a vention and cessation programs for all 50 states and the District
lifespan similar to never smokers.36 Smoking cessation reduces of Columbia. In fiscal year 2015, 7 states allocated 50% or more
the risk of lung and other cancers caused by smoking. In addi- of CDC-recommended funding levels for tobacco control pro-
tion, cancer survivors who quit smoking have better health grams.24 States that have previously invested in comprehensive
outcomes than those who do not.1

tobacco control programs, such as California, Massachusetts, 10. Centers for Disease Control and Prevention. Youth Online: High
and Florida, have reduced smoking rates and saved millions of School YRBS. Available from URL: http://nccd.cdc.gov/youthonline/App/
Default.aspx [accessed September, 15, 2014].
dollars in tobacco-related health care costs.41 For more informa-
11. Arrazola RA, Singh T, Corey CG, et al. Tobacco use among middle
tion about tobacco control, visit cancer.org/statistics to view the
and high school students United States, 2011-2014. MMWR Morb Mor
most recent edition of Cancer Prevention & Early Detection Facts tal Wkly Rep. 2015;64: 381-385.
& Figures.
12. Baker F, Ainsworth SR, Dye JT, et al. Health risks associated with
cigar smoking. JAMA. 2000;284: 735-740.
Conclusion 13. Shanks TG, Burns DM. Disease consequences of cigar smoking.
National Cancer Institute, Smoking and Tobacco Control, Monograph 9:
Substantial progress has been made in reducing the disease bur- Cigars Health Effects and Trends. Washington, DC: National Institutes
den from tobacco over the 52 years since the first report of the of Health, 1998.
Surgeon Generals Advisory Committee on Smoking and Health 14. Shapiro JA, Jacobs EJ, Thun MJ. Cigar smoking in men and risk of
in 1964. Smoking prevalence has been reduced by more than death from tobacco-related cancers. J Natl Cancer Inst. 2000;92: 333-337.
half, and millions of premature deaths have been averted. Nev- 15. Centers for Disease Control and Prevention. Consumption of ciga-
ertheless, more needs to be done to further reduce the health rettes and combustible tobacco United States, 2000-2011. MMWR
and economic burden of tobacco. Numerous studies confirm Morb Mortal Wkly Rep. 2012;61: 565-569.
that a comprehensive approach to tobacco control, including 16. Agaku IT, King BA, Husten CG, et al. Tobacco product use among
adults - United States, 2012-2013. MMWR Morb Mortal Wkly Rep. 2014;63:
higher taxes, 100% smoke-free environments, coverage for
542-547.
tobacco dependence treatment, full implementation of the FDA
17. US Department of Health and Human Services. How Tobacco Smoke
Family Smoking Prevention and Tobacco Control Act, and vigor- Causes Disease The Biology and Behavioral Basis for Smoking-Attrib-
ous tobacco counter-advertising, can be successful in reducing utable Disease. Rockville, MD: US Department of Health and Human
deaths, disease, and economic disruption from tobacco use. Services, Public Health Service, Centers for Disease Control and Pre-
vention, Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health, 2010.
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Disease Prevention and Health Promotion, 2014. geon General. Washington, DC: US Department of Health and Human
2. Centers for Disease Control and Prevention. Smoking-attributable Services, Centers for Disease Control and Prevention and Health Promo-
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3. Secretan B, Straif K, Baan R, et al. A review of human carcinogens cular Effects: Making Sense of the Evidence. Washington, DC: IOM, 2009.
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4. Jacobs EJ, Newton CC, Carter BD, et al. What proportion of cancer Morb Mortal Wkly Rep. 2010;59: 1141-1146.
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smoking? Ann Epidemiol. 2015;25: 179-182.e171. Cancer Prevention. Volume 13: Evaluating the Effectiveness of Smoke-free
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Nutrition & Physical Activity

The World Cancer Research Fund estimates that about 20% of Recommendations for Individual
cancers that occur in the US are due to the combined effects of
excess alcohol consumption, poor nutrition, physical inactivity,
Choices
and excess weight, and thus could be prevented.1 For the 83% of 1. Achieve and maintain a healthy weight
people who dont smoke, maintaining a healthy body weight, throughout life.
being physically active on a regular basis, and eating a healthy Be as lean as possible throughout life without being
diet are the most important ways to reduce cancer risk. Studies underweight.
estimate that adults who follow these healthy lifestyle recom-
Avoid excess weight gain at all ages. For those who are cur-
mendations, including not smoking, are 36% less likely to be
rently overweight or obese, losing even a small amount of
diagnosed with cancer and 40% less likely to die from the dis-
weight has health benefits and is a good place to start.
ease.2 The American Cancer Societys nutrition and physical
activity guidelines emphasize the importance of weight control, Engage in regular physical activity and limit consumption of
physical activity, healthy dietary patterns, and limited, if any, high-calorie foods and beverages as key strategies for main-
alcohol consumption in reducing cancer risk and helping people taining a healthy weight.
stay well. Unfortunately, the majority of Americans are not Overweight and obesity are clearly associated with increased
meeting these recommendations.3 The Societys guidelines also risk for developing many cancers, including adenocarcinoma of
include recommendations for community action because of the the esophagus and cancers of the breast (in postmenopausal
large influence that physical and social environments have on women), colorectum, endometrium, kidney, liver, and pancreas.
individual food and activity behaviors. Overweight and obesity may also be associated with an increased
The following recommendations reflect the best nutrition and risk of aggressive prostate cancer, non-Hodgkin lymphoma,
physical activity evidence available to help Americans reduce multiple myeloma, and cancers of the cervix, ovary, and gall-
their risk of cancer and promote overall health. See Cancer Pre- bladder. Abdominal fatness in particular is convincingly
vention & Early Detection Facts & Figures at cancer.org/statistics associated with colorectal cancer, and probably related to higher
for more detailed information on how nutrition, physical activ- risk of pancreatic and endometrial cancers. In addition, accu-
ity, and body weight affect cancer risk. mulating evidence suggests that obesity increases the risk for
cancer recurrence and decreases survival rates for several can-
cers.4, 5 Some studies have shown that intentional weight loss is

associated with decreased cancer risk among women, but the factors. Physical activity also improves the quality of life of can-
evidence is less clear for men.6 cer patients and has been associated with reduced cancer
recurrence and overall mortality in cancer survivor groups,
The prevalence of obesity among US adults 20-74 years of age
including breast, colorectal, prostate, and ovarian cancer.
more than doubled between 1976-1980 (15%) and 1999-2000
(31%), but since 2005 has remained around 35%.7 However, Despite the wide variety of health benefits from being active, in
among certain subgroups, such as Hispanic (45%) and non-His- 2014 30% of adults reported no leisure-time activity, and only 50%
panic black (57%) women, obesity prevalence is much higher. met recommended levels of aerobic activity. Similarly, only 25% of
Similar to adults, obesity among children and adolescents has children 12 to 15 years of age and 27% of high school students met
risen rapidly in the past several decades across race, ethnicity, recommendations. However, recent data released by the CDC
and gender. In 2011-2012, 17% of American children 2 to 19 years indicate that trends may be slightly improving. The proportion of
of age were obese, including 20% of blacks, 22% of Hispanics, adults meeting recommended aerobic and muscle-strengthening
14% of non-Hispanic whites, and 7% of Asians.8 However, a guidelines increased from 14% in 1998 to 22% in 2014.
recent study suggests that obesity rates among children and
adolescents have plateaued over the past decade, with declines 3. Consume a healthy diet, with an emphasis on
reported among children 2 to 5 years of age, perhaps an indica- plant foods.
tion that the obesity epidemic is stalling.8 Because overweight in Choose foods and beverages in amounts that help achieve
youth tends to continue throughout life, efforts to establish and maintain a healthy weight.
healthy body weight patterns should begin in childhood. Limit consumption of red and processed meat.
The high prevalence of obesity in children and adolescents may Eat at least 2 cups of vegetables and fruits each day.
impact the future cancer burden. More than likely, the obesity Choose whole grains instead of refined-grain products.
epidemic is already impacting cancer rates. For example, rising
endometrial cancer incidence rates likely reflect, to some extent, There is strong scientific evidence that healthy dietary patterns,
the increasing prevalence of obesity.9 Additionally, some in combination with regular physical activity, are needed to
researchers have speculated that the longstanding, historic maintain a healthy body weight and to reduce cancer risk. Stud-
increases in life expectancy in the US may level off or even ies have shown that individuals who eat more processed and red
decline within the first half of this century as a result of the meat, potatoes, refined grains, and sugar-sweetened beverages
obesity epidemic. and foods are at a higher risk of developing or dying from a vari-
ety of cancers. Alternatively, adhering to a diet that contains a
2. Adopt a physically active lifestyle. variety of fruits and vegetables, whole grains, and fish or poultry
Adults should engage in at least 150 minutes of moderate- and fewer red and processed meats is associated with lower risk.
intensity or 75 minutes of vigorous-intensity activity each Recent studies found that dietary and lifestyle behaviors consis-
week, or an equivalent combination, preferably spread tent with the American Cancer Society nutrition and physical
throughout the week. activity guidelines are associated with lower mortality rates for
all causes of death combined, and for cancer and cardiovascular
Children and adolescents should engage in at least 1 hour
diseases specifically.11, 12 Despite the known benefits of a healthy
of moderate- or vigorous-intensity activity each day, with
diet, Americans are not following recommendations; according
vigorous-intensity activity at least three days each week.
to the US Department of Agriculture, the majority of Americans
Limit sedentary behavior such as sitting, lying down, would need to substantially lower their intake of added sugars,
and watching television and other forms of screen-based added fats, refined grains, and sodium, and increase their con-
entertainment. sumption of fruits, vegetables, whole grains, and low-fat dairy
Doing any intentional physical activity above usual activities products in order to meet the 2010 Dietary Guidelines for
can have many health benefits. Americans.
Living a physically active lifestyle helps reduce the risk of a vari- The scientific study of nutrition and cancer is highly complex,
ety of cancer types, as well as heart disease, diabetes, and many and many important questions remain unanswered. It is not
other diseases. Scientific evidence indicates that physical activ- presently clear how single nutrients, combinations of nutrients,
ity may reduce the risk of cancers of the breast, colon, and over-nutrition, and energy imbalance, or the amount and distri-
endometrium, as well as advanced prostate cancer.10 Physical bution of body fat and nutritional exposures at particular stages
activity also indirectly reduces the risk of developing obesity- of life, affect a persons risk of specific cancers. Until more is
related cancers because of its role in helping to maintain a known about the specific components of diet that influence can-
healthy weight. Being active is thought to reduce cancer risk cer risk, the best advice is to consume a mostly plant-based diet
largely by improving energy metabolism and reducing circulat- that limits red and processed meats and emphasizes a variety of
ing concentrations of estrogen, insulin, and insulin-like growth vegetables, fruits, and whole grains. A special emphasis should

be placed on controlling total caloric intake to help achieve and environment are required to help individuals make smart food
maintain a healthy weight. and physical activity choices and maintain a healthy body weight.
4. If you drink alcoholic beverages, limit

consumption. References
1. World Cancer Research Fund International. Continious Update Proj-
People who drink alcohol should limit their intake to no more
ect: Cancer preventability estimates for diet, nutrition, body fatness, and
than two drinks per day for men and one drink per day for physical activity. London, UK: World Cancer Research Fund Interna-
women. Alcohol consumption is a risk factor for cancers of the tional, 2015.
mouth, pharynx, larynx, esophagus, liver, colorectum, female 2. Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing
breast, and possibly pancreas.3, 10, 13, 14 For each of these cancers, H. Healthy living is the best revenge: findings from the European Pro-
risk increases substantially with the intake of more than two spective Investigation Into Cancer and Nutrition-Potsdam study. Arch
drinks per day. Even a few drinks per week may be associated Intern Med. 2009;169: 1355-1362.
with a slightly increased risk of breast cancer in women.15 Alco- 3. Kushi LH, Doyle C, McCullough M, et al. American Cancer Society
Guidelines on Nutrition and Physical Activity for cancer prevention:
hol consumption combined with tobacco use increases the risk
reducing the risk of cancer with healthy food choices and physical activ-
of cancers of the mouth, larynx, and esophagus far more than ity. CA Cancer J Clin. 2012;62(1): 30-67.
either drinking or smoking alone.10 4. Campbell PT, Newton CC, Dehal AN, Jacobs EJ, Patel AV, Gapstur SM.
Impact of body mass index on survival after colorectal cancer diagnosis:
The American Cancer Society the Cancer Prevention Study-II Nutrition Cohort. J Clin Oncol. 2012;30:
42-52.
Recommendations for Community 5. Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and
Action biochemical recurrence: a systematic review and meta-analysis. Cancer
Prev Res (Phila). 2011;4: 486-501.
Many Americans encounter substantial barriers to consuming a
6. Birks S, Peeters A, Backholer K, OBrien P, Brown W. A systematic
healthy diet and engaging in regular physical activity. Among review of the impact of weight loss on cancer incidence and mortality.
those barriers that have collectively contributed to increased Obes Rev. 2012;13: 868-891.
obesity are: limited access to affordable, healthy foods; increased 7. Fryar CD, Carroll MD, Ogden CL. Prevalence of Overweight, Obesity,
portion sizes, especially of restaurant meals; marketing and and Extreme Obesity Among Adults: United States, 1960-1962 through
advertising of foods and beverages high in calories, fat, and 2011-2012. National Center for Health Statistics. September 2014. Avail-
added sugar, particularly to kids; schools and worksites that are able from URL: http://www.cdc.gov/nchs/data/hestat/obesity_adult_11_12/obe-
sity_adult_11_12.pdf.
not conducive to good health; community design that hinders
8. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and
physical activity and promotes sedentary behavior; and eco-
adult obesity in the United States, 2011-2012. JAMA. 2014;311: 806-814.
nomic and time constraints.
9. Polednak AP. Estimating the number of U.S. incident cancers attribut-
The Societys nutrition and physical activity guidelines include able to obesity and the impact on temporal trends in incidence rates for
obesity-related cancers. Cancer Detect Prev. 2008;32: 190-199.
Recommendations for Community Action because of the tre-
mendous influence that the surrounding environment has on 10. World Cancer Research Fund/American Institute for Cancer Research.
The Associations Between Food, Nutrition and Phyisical Activity and the
individual food and activity choices. Acknowledging that revers- Prevention of Cancer: A Global Perspective. Washington, DC: World Cancer
ing obesity trends will require extensive policy and environmental Research Fund/American Institute for Cancer Research 2007.
changes, the Society calls for public, private, and community 11. Kabat G, Matthews C, Kamensky V, Hollenbeck A, Rohan TE. Adher-
organizations to create social and physical environments that ence to cancer prevention guidelines and cancer incidence, cancer mor-
support the adoption and maintenance of healthy eating and tality, and total mortality: a prospective cohort study. Am J Clin Nutr.
physical activity behaviors to help people stay well. 2015;101: 558-569.
12. McCullough ML, Patel AV, Kushi LH, et al. Following cancer preven-
Achieving these recommendations requires multiple strategies tion guidelines reduces risk of cancer, cardiovascular disease, and all-
and bold action, ranging from the implementation of community cause mortality. Cancer Epidemiol Biomarkers Prev. 2011;20: 1089-1097.
and workplace health promotion programs to policies that affect 13. International Agency for Research on Cancer. IARC Monographs
community planning, transportation, school-based physical on the Evaluation of Carcinogenic Risks to Humans. Volume 83: Alcohol
activity, and food services. The tobacco control experience has Drinking. Lyon, France: IARC Press, 1988.
shown that policy and environmental changes at the national, 14. Secretan B, Straif K, Baan R, et al. A review of human carcinogens
Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet
state, and local levels are critical to achieving changes in indi-
Oncol. 2009;10: 1033-1034.
vidual behavior. Measures such as smoke-free laws and increases
15. Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moder-
in cigarette excise taxes have been highly effective in deterring ate alcohol consumption during adult life, drinking patterns, and breast
tobacco use. To avert an epidemic of obesity-related disease, sim- cancer risk. JAMA. 2011;306(17):1884-1890.
ilar purposeful changes in public policy and in the community

Cancer Disparities
Eliminating disparities in the cancer burden among different treatment, with poverty as the overriding factor. According to the
segments of the US population, defined in terms of socioeco- US Census Bureau, in 2014, 26% of blacks and 24% of Hispanics/
nomic status (income, education, insurance status, etc.), race/ Latinos lived below the poverty line, compared to 10% of non-His-
ethnicity, geographic location, sex, and sexual orientation, is an panic whites. Moreover, 12% of blacks and 20% of Hispanics/
overarching goal of the American Cancer Society. The causes of Latinos were uninsured, compared to 8% of non-Hispanic whites.
health disparities within each of these groups are complex and
Discrimination is another factor that contributes to racial/eth-
include interrelated social, economic, cultural, environmental,
nic disparities in cancer mortality. Racial and ethnic minorities
and health system factors. However, disparities predominantly
tend to receive lower-quality health care than non-Hispanic
arise from inequities in work, wealth, education, housing, and
whites even when insurance status, age, severity of disease, and
overall standard of living, as well as social barriers to high-qual-
health status are comparable. Social inequalities, including
ity cancer prevention, early detection, and treatment services.
communication barriers and provider/patient assumptions, can
affect interactions between patients and physicians and contrib-
Socioeconomic Status ute to miscommunication and/or delivery of substandard care.
People with lower socioeconomic status (SES) have higher cancer In addition to poverty and social discrimination, cancer occur-
death rates than those with higher SES, regardless of demographic rence in a population may also be influenced by cultural and/or
factors such as race/ethnicity. For example, cancer mortality rates inherited factors that decrease or increase risk. Individuals who
among both black and non-Hispanic white men with 12 or fewer maintain a primarily plant-based diet or do not use tobacco
years of education are almost 3 times higher than those of college because of cultural or religious beliefs have a lower risk of many
graduates for all cancers combined because of limited access to cancers compared to non-Hispanic whites. For example, His-
prevention, early detection, and treatment services. panics and Asians have lower rates of lung cancer because they
People with lower SES also have generally higher cancer inci- have historically been less likely to smoke (Table 9). Conversely,
dence rates. This is in part because they are more likely to engage because these populations include a large number of recent
in behaviors that increase cancer risk, such as using tobacco, immigrants, they have higher rates of cancers related to infec-
not being physically active, and having an unhealthy diet, but tious agents (e.g., stomach, liver) because of higher prevalence of
also due to higher prevalence of cancer-causing infections, infection in immigrant countries of origin. Genetic factors may
workplace exposures, and other environmental exposures. Fac- also explain some differences in cancer incidence, such as the
tors that contribute to a higher prevalence of cancer risk factors higher frequency of mutations in the breast cancer susceptibil-
in this population include marketing strategies by tobacco com- ity genes BRCA1 and BRCA2 among women of Ashkenazi Jewish
panies and fast food chains that target these populations and descent. However, it is important to note that genetic differences
environmental and/or community factors that provide few associated with race or ethnicity make only a minor contribu-
opportunities for physical activity and access to fresh fruits and tion to the disparate cancer burden between populations.
vegetables. In addition to higher rates of new cancer diagnoses, Following is a brief overview of the cancer burden for the four
lower SES groups are less likely to survive after a cancer diagno- major minority groups in the US. It is important to note that
sis because the disease is often detected at an advanced stage although cancer data in the US are primarily reported in terms
and because they are less likely to receive standard treatment. of broad racial and ethnic categories, these populations are very
Barriers to preventive care, early detection, and optimal treat- heterogeneous, with substantial variation in the cancer burden
ment include inadequate health insurance; financial, structural, within each group. In addition, cancer information for several
and personal barriers to health care; and low health literacy racial and ethnic groups, especially American Indians and
rates. Progress in reducing cancer death rates has also been Alaska Natives (AIANs), is known to be incomplete due to mis-
slower in people with lower SES because of the delay in the dis- classification on medical and death records. Although efforts
semination of improved early detection and treatment in this have been made to collect more accurate information, rates pre-
underserved population. sented for AIANs in particular likely do not represent the true
cancer burden in this population.
Racial and Ethnic Minorities Non-Hispanic Black: Non-Hispanic black (henceforth black)
Disparities in the cancer burden among racial and ethnic minori- men have higher overall cancer incidence (592.3 per 100,000)
ties largely reflect obstacles to receiving health care services and death (267.7) rates than any other major racial or ethnic
related to cancer prevention, early detection, and high-quality group, 12% and 27% higher, respectively, than non-Hispanic

Table 9. Incidence and Death Rates* for Selected Cancers by Site, Race, and Ethnicity, US, 2008-2012
Non-Hispanic Non-Hispanic Asian and Pacific American Indian
Incidence white black Islander and Alaska Native Hispanic/Latino
All sites
Male 528.9 592.3 316.8 423.3 408.5
Female 436.2 408.1 287.5 372.9 330.4
Breast (female) 128.1 124.3 88.3 91.9 91.9
Colon & rectum
Male 47.4 60.3 39.0 50.4 44.6
Female 36.2 44.1 29.2 40.1 30.6
Kidney & renal pelvis
Male 21.8 24.2 10.8 29.7 20.6
Female 11.3 13.0 4.9 18.3 11.8
Liver & intrahepatic bile duct
Male 9.3 16.5 20.6 18.7 19.3
Female 3.2 4.8 7.9 8.9 7.2
Lung & bronchus
Male 79.3 93.4 47.4 66.2 43.3
Female 58.7 51.4 28.3 52.7 26.0
Prostate 123.0 208.7 67.8 90.5 112.1
Stomach
Male 7.8 15.1 14.5 12.0 13.5
Female 3.5 8.0 8.5 6.6 7.8
Uterine cervix 7.1 10.0 6.3 9.4 10.2
Mortality
All sites
Male 210.6 267.7 128.4 186.7 148.0
Female 149.2 170.4 91.2 133.9 99.4
Breast (female) 21.9 31.0 11.4 15.0 14.5
Colon & rectum
Male 18.2 27.6 13.0 18.8 15.6
Female 12.9 18.2 9.4 15.6 9.6
Kidney & renal pelvis
Male 5.9 5.7 2.9 8.7 5.0
Female 2.6 2.6 1.2 4.7 2.4
Liver & intrahepatic bile duct
Male 7.6 12.8 14.5 13.9 12.9
Female 3.1 4.4 6.1 6.3 5.6
Lung & bronchus
Male 62.2 74.9 34.0 49.1 29.5
Female 41.4 36.7 18.2 32.1 13.7
Prostate 19.9 47.2 9.4 20.2 17.8
Stomach
Male 3.6 9.4 7.9 7.4 7.2
Female 1.8 4.5 4.7 3.6 4.2
Uterine cervix 2.0 4.1 1.8 3.5 2.7
Hispanic origin is not mutually exclusive from Asian/Pacific Islander or American Indian/Alaska Native. *Rates are per 100,000 population and age adjusted to the 2000
US standard population. Data based on Indian Health Service Contract Health Service Delivery Areas. Incidence rates exclude data from Kansas.
Source: Incidence North American Association of Central Cancer Registries, 2015. Mortality US mortality data, National Center for Health Statistics, Centers for
Disease Control and Prevention, 2015.

Figure 5. Geographic Patterns in Lung Cancer Death Rates* by State, US, 2008-2012
Males
WA
MT ND ME
OR MN VT
ID NH
SD MA
WI NY
WY
MI RI
CT
IA PA
NV NE NJ
OH
UT IL IN DE
CA CO WV MD Rate per 100,000 males
KS VA
MO DC 26.4 - 46.6
KY
NC 46.7 - 58.2
TN
AZ OK 58.3 - 68.0
NM AR SC 68.1 - 77.4
MS AL GA 77.5 - 92.2
AK
TX LA
FL
HI
Females
WA
MT ND ME
OR MN VT
ID NH
SD MA
WI NY
WY
MI RI
CT
IA PA
NV NE NJ
OH
UT IL IN DE
CO
Rate per 100,000 females
CA WV MD
KS VA
MO DC 15.6 - 27.2
KY
27.3 - 35.8
NC
TN
AZ OK 35.9 - 41.4
NM AR SC 41.5 - 45.3
MS AL GA 45.4 - 55.2
AK
TX LA
FL
HI
*Rates adjusted to the 2000 US standard population.

Source: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2015.

whites (528.9 and 210.6) (Table 9, page 51). Cancer death rates ethnic population 3 times higher than those among APIs, who
in black men are twice those in Asian and Pacific Islanders have the lowest rates (Table 9, page 51). Kidney cancer death
(128.4), who have the lowest rates. In particular, prostate cancer rates are highest among AIAN populations in the Northern and
death rates in black men (47.2) are more than double those of any Southern Plains, while they are substantially lower in the East
other group, and are 137% higher than non-Hispanic whites and Pacific Coast regions. Rates of lung cancer are also particu-
(19.9). Black women have 14% higher cancer death rates than larly high among AIAN men and women in some regions. For
non-Hispanic white women despite 6% lower incidence rates. example, AIAN men living in the Northern Plains or Alaska have
See Cancer Facts & Figures for African Americans, available lung cancer incidence rates about 50% higher than whites living
online at cancer.org/statistics, for more information on cancer in in those areas. Differences in the prevalence of smoking, obesity,
black Americans. and hypertension likely contribute to these disparities.
Hispanic/Latino: Cancer patterns in Hispanics generally For information about American Cancer Society advocacy efforts
reflect those in immigrant countries of origin, but become more dedicated to reducing the cancer burden among minority and
similar to non-Hispanic white Americans across generations medically underserved populations, see Advocacy on page 62.
due to acculturation. Hispanics have lower rates of the cancers
that are most common in the US (female breast, colorectum,
lung, and prostate), but among the highest rates of cancers asso-
Geographic Variability
ciated with infectious agents. For example, compared to Cancer rates in the US vary by geographic area, with larger dif-
non-Hispanic whites, cervical cancer incidence rates are 44% ferences for some cancer sites than others. Lung cancer, for
higher, and liver and stomach cancer incidence rates are about example, shows the most striking variation by state (Figure 5).
twice as high (Table 9, page 51). See Cancer Facts & Figures for Lung cancer death rates are more than 3-fold higher in Kentucky
Hispanics/Latinos, available online at cancer.org/statistics for (92 and 55 per 100,000 in men and women, respectively) the
more information. state with the highest rates than in Utah (26 and 16 per 100,000
in men and women, respectively), which has the lowest rates.
Asian and Pacific Islander (API): Cancer patterns in APIs are These differences reflect the substantial historic variation in
similar to those in Hispanics (Table 9, page 51). APIs have the smoking prevalence among states, which continues today. For
lowest overall cancer incidence and death rates, but among the example, smoking prevalence in adults in 2013 ranged from 10%
highest rates of liver and stomach cancers, about double those in Utah to 27% in Kentucky and West Virginia. Some of this dif-
among non-Hispanic whites. In contrast to Hispanics, however, ference reflects state tobacco control policies. Geographic
APIs overall have the lowest cervical cancer incidence and mor- variations in cancer occurrence also reflect differences in envi-
tality rates of all major racial/ethnic groups , although rates are ronmental exposures, socioeconomic factors related to
elevated among some API subpopulations. For more informa- population demographics, and screening behaviors. There is lit-
tion, see the special section on page 25. tle state variation in the occurrence of cancers that are less
American Indian and Alaska Native (AIAN): AIANs have the influenced by behavior and/or early detection tests, such as non-
highest kidney cancer incidence and death rates of any racial or Hodgkin lymphoma (Table 4, page 7).
The Global Fight against Cancer

The ultimate mission of the American Cancer Society is to elimi- Moreover, the global cancer burden is growing at an alarming
nate cancer as a major health problem. Because cancer knows pace; in 2030 alone, about 21.7 million new cancer cases and 13.0
no boundaries, this mission extends around the world. Cancer is million cancer deaths are expected to occur, simply due to the
an enormous global health burden, touching every region and growth and aging of the population. The future burden may be
socioeconomic group. Today, cancer accounts for about 1 in further increased by the adoption of behaviors and lifestyles
every 7 deaths worldwide more than HIV/AIDS, tuberculosis, associated with economic development and urbanization (e.g.,
and malaria combined. In 2012, there were an estimated 14.1 smoking, poor diet, physical inactivity, and reproductive pat-
million cases of cancer diagnosed around the world and 8.2 mil- terns) in low- and middle-income countries. Tobacco use is a
lion cancer deaths. More than 60% of cancer deaths occur in major cause of the increasing global burden of cancer as the
low- and middle-income countries, many of which lack the med- number of smokers worldwide continues to grow.
ical resources and health systems to support the disease burden.

Worldwide Tobacco Use empowering the worlds cancer societies and anti-tobacco advo-
cates. The Societys Global Cancer Control and Intramural
Tobacco-related diseases are the most preventable cause of
Research departments are raising awareness about the growing
death worldwide, responsible for the deaths of approximately
global cancer burden and promoting evidence-based cancer and
half of all long-term tobacco users.
tobacco control programs.
Each year, tobacco use is responsible for almost 6 mil-
The Society works to reduce the global burden of cancer by pre-
lion deaths, 80% of which are in low- and middle-income
venting cancer, saving lives, diminishing suffering, catalyzing
countries; by 2030, this number is expected to increase to 8
local responses, and shaping the global policy agenda. Our
million.
efforts focus on low- and middle-income countries.
Between 2002 and 2030, tobacco-attributable deaths are
expected to decrease by 9% in high-income countries, while Make cancer control a political and public health priority.
increasing by 100% (from 3.4 million to 6.8 million) in low- Noncommunicable diseases (NCDs) such as cancer, heart dis-
and middle-income countries. ease, and diabetes account for about 65% of the worlds deaths.
Although 67% of these deaths occur in low- and middle-income
The first global public health treaty under the auspices of the countries, less than 3% of private and public health funding is
World Health Organization, the Framework Convention on allocated to prevent and control NCDs in these areas. In Septem-
Tobacco Control (FCTC), was unanimously adopted by the ber 2011, world leaders gathered at a special United Nations
World Health Assembly on May 21, 2003, and subsequently High-level Meeting and adopted a Political Declaration that ele-
entered into force as a legally binding accord for all ratifying vates cancer and other NCDs on the global health and
states on February 27, 2005. The purpose of the treaty is to fight development agenda and includes key commitments to address
the devastating health and economic effects of tobacco on a these diseases. In 2012, the decision-making body of the World
global scale by requiring parties to adopt a comprehensive range Health Organization (WHO) approved a resolution calling for a
of tobacco control measures. It features specific provisions to 25% reduction in premature deaths from NCDs by 2025 (also
control both the global supply of and demand for tobacco, known as 25 by 25). This ambitious goal set the stage for the
including the regulation of tobacco product contents, packag- adoption of a comprehensive framework aimed at monitoring
ing, labeling, advertising, promotion, sponsorship, taxation, NCD risk factors (e.g., smoking prevalence) and indicators of
illicit trade, youth access, exposure to secondhand tobacco increased access to breast and cervical cancer screening, pallia-
smoke, and environmental and agricultural impacts. Parties to tive care, and vaccination coverage. At a United Nations summit
the treaty are expected to strengthen national legislation, enact in September 2015, government leaders formally adopted the
effective domestic tobacco control policies, and cooperate inter- Sustainable Development Goals, including a stand-alone target
nationally to reduce global tobacco consumption. A number of on NCDs and a number of NCD-related targets. This is the first
major tobacco-producing nations, including Argentina, Indone- time that NCDs have been included in these goals as a priority
sia, Malawi, and the United States, have not ratified the treaty. for all countries. To maintain the momentum for making cancer
As of November 2015, 180 out of 196 eligible parties have rati- and other NCDs a global priority, the Society collaborates with
fied or acceded to the treaty, representing approximately 89% key partners, including the NCD Alliance, the Union for Interna-
of the worlds population. tional Cancer Control, the WHOs International Agency for
Research on Cancer, the NCD Roundtable, and the Taskforce on
About one-third of the worlds population was covered by at
Women and Non-Communicable Diseases.
least one comprehensive tobacco control measure in 2014, up
from about 15% in 2008. Last year (2015) was also a critical time for making womens can-
The WHO estimates that 18% of the worlds population lives cers a global health and development priority. Cervical and breast
in smoke-free environments. cancers are the most commonly diagnosed cancers among
women in most areas of the world. Focusing on fighting these
Although tobacco excise tax increases are among the most
cancers is a priority for the American Cancer Society, not only
cost-effective tobacco control strategies, only 10% of the world
because they affect so many women, but also because cost-effec-
population is covered by comprehensive tobacco tax policy.
tive and proven prevention, screening, and treatment options
exist. To strengthen the case for greater investments in cervical
The Role of the American Cancer cancer prevention and control, the Society commissioned Har-
Society vard Universitys T.H. Chan School of Public Health to estimate
the cost of achieving comprehensive global cervical cancer pre-
With more than a century of experience in cancer control, the
vention over the next decade in low- and middle-income
American Cancer Society is uniquely positioned to help in lead-
countries. The study found that scaling up comprehensive pre-
ing the global fight against cancer and tobacco by assisting and
vention steadily from 2015 through 2024 would cost $18.3 billion

($8.6 billion for vaccination and $9.7 billion for screening) and morphine available for the first time in several years and set up
that 480 million women would be screened and 290 million girls a local production system in 27 teaching hospitals that lowered
would be vaccinated. the price for patients by 80% to 90%. The Society continues to
support the national morphine production facility in Uganda,
Develop cancer control capacity globally. Many governments
which has been operating since 2010, and is supporting Kenya to
in low- and middle-income countries are ill-prepared to ade-
replicate the model in the national hospital in Nairobi. The Soci-
quately address the increasing burden of cancer. In many cases,
ety is also training health workers in more than 25 teaching and
civil society actors (nongovernmental organizations, institu-
referral hospitals across the 5 countries through the Pain-Free
tions, and individuals) are also not yet fully engaged in cancer
Hospital Initiative, a 1-year hospital-wide quality improvement
control efforts.
initiative designed to change clinical practice by integrating
The Societys Global Capacity Development program is intended effective, high-quality pain treatment into hospital-based
to strengthen the civil society response to cancer in focus coun- services.
tries around the world, taking advantage of more than 100 years
Increase awareness about the global cancer burden. The
of institutional experience and expertise in cancer control. This
Society continues to work with global collaborators to increase
program provides intensive and culturally appropriate techni-
awareness about the growing global cancer and tobacco bur-
cal assistance to targeted organizations in low- and
dens and their impact on low- and middle-income countries. In
middle-income countries. The programs areas of intervention
addition to print publications, the Society website, cancer.org,
include the basic elements of organizational capacity develop-
provides cancer information to millions of individuals through-
ment, such as governance, financial management, fundraising,
out the world. In 2014, 40% of visits to the website came from
program design and management, and monitoring and
outside the US. Information is currently available in English,
evaluation.
Spanish, Chinese, Bengali, Hindi, Korean, Urdu, and
Make effective pain treatment available to all in need. Vietnamese.
Untreated moderate to severe pain, which is experienced by
Visit the Societys Global Health program website at cancer.org/
about 80% of people with advanced cancer, is a consistent fea-
international and global.cancer.org for more information on the
ture of cancer care in resource-limited settings. Improved
global cancer burden. In addition, recent publications by the
access to essential pain medicines is arguably the easiest and
Intramural Research department include:
least expensive need to meet, would do the most to relieve suf-
fering, and may also extend survival, according to recent data. Global Cancer Facts & Figures, 3rd Edition (cancer.org/statistics)
The Society has projects in Nigeria, Ethiopia, Kenya, Uganda, The Cancer Atlas, Second Edition (canceratlas.cancer.org)
and Swaziland to improve access to essential pain medicines. In
The Tobacco Atlas, Fifth Edition (tobaccoatlas.org)
Nigeria, the Society collaborated with the government to make
The American Cancer Society

In 1913, 10 physicians and 5 laypeople founded the American How the American Cancer Society
Society for the Control of Cancer. Its purpose was to raise aware-
ness about cancer symptoms, treatment, and prevention; to
Is Organized
investigate the causes of cancer; and to compile cancer statis- The American Cancer Society, Inc., is a 501(c)(3) nonprofit corpo-
tics. Later renamed the American Cancer Society, Inc., the ration governed by a Board of Directors that sets policy,
organization now works with approximately 2.5 million volun- establishes long-term goals, monitors general operations, and
teers to save lives by helping people stay well and get well, by approves organizational outcomes and allocation of resources.
finding cures, and by fighting back against the disease. We com- The Societys structure includes a central corporate office in
bine our relentless passion with the wisdom of over a century of Atlanta, Georgia, as well as regional and local offices supporting
experience to make this vision a reality, and we get results. 11 geographic Divisions, and more than 300 local offices in those
Thanks in part to our contributions, more than 1.7 million can- Divisions. The corporate office is responsible for overall strate-
cer deaths have been averted in the US in the past two decades. gic planning; corporate support services such as human
resources, financial management, IT, etc.; development and
implementation of global and nationwide endeavors such as our
groundbreaking research program, our global program, and our

24-hour call center; and technical support and materials for More than 5 million new cases of skin cancer will be diagnosed
Divisions and their local offices. in the US this year. Thats why the American Cancer Society and
other members of the National Council on Skin Cancer Preven-
Our Divisions and local offices are organized to engage communi-
tion have designated the Friday before Memorial Day as Dont
ties in the cancer fight, delivering patient programs and services
Fry Day. The Society promotes skin cancer prevention and
and raising money at the local level. Offices are strategically
awareness educational messages in support of Dont Fry Day
located around the country in an effort to maximize the impact of
and year-round.
our efforts and be as efficient as possible with the money donated
to the Society to help finish the fight against cancer. The Society also offers many products to employers and other
systems to help their employees stay well and reduce their can-
In addition, the Society has a nonprofit, nonpartisan 501(c)(4)
cer risk, too. These include:
advocacy affiliate called the American Cancer Society Cancer
Action Network SM (ACS CAN). Headquartered in Washington, The Workplace Health Assessment program, which surveys
DC but including staff and volunteers in all 50 states, ACS CAN a companys health and wellness practices to provide recom-
uses applied policy analysis, direct lobbying, grassroots action, mended strategies for increasing effectiveness of current
and media advocacy to ensure elected officials nationwide pass programs, developing target initiatives to meet employees
and effectively implement laws that help save lives from cancer. needs, and strengthening the culture of health for the organi-
zation. Targeted behaviors include organizational readiness,
Volunteers tobacco control, cancer screening, healthy eating, physical
The Society relies on the strength of millions of dedicated volun- activity, and cancer care.
teers. Supported by professional staff, Society volunteers drive The Freshstart group-based tobacco cessation program,
every part of our mission. They raise funds to support crucial which is designed to help employees plan a successful quit
research, provide cancer patients rides to and from treatments, attempt by providing essential information, skills for coping
and give one-on-one support to those facing a cancer diagnosis with cravings, and social support
and thats just the beginning. The Content Subscription Service, an electronic toolkit
subscription offered by the Society to employers that sup-
How the American Cancer Society ports the health and wellness needs of employees with
information about cancer prevention and early detection, as
Saves Lives well as support services and resources for those facing the
As an organization of 2.5 million strong, the American Cancer disease
Society is committed to a world free from the pain and suffering
Healthy Living, a monthly electronic newsletter produced by
of cancer.
the American Cancer Society that teaches the importance of
Prevention and Early Detection making healthy lifestyle choices. The e-newsletter focuses on
exercising, eating better, and maintaining a healthy weight.
The American Cancer Society is doing everything in our power
Healthy Living is available in both English and Spanish, and
to prevent cancer. We are diligent in encouraging cancer screen-
the content has been edited by the Societys scientific staff to
ings for early detection and promote healthy lifestyles by bringing
ensure that the most up-to-date and accurate information is
attention to obesity, healthy diets, physical activity, and avoid-
being provided.
ing tobacco.
The 10-week Active For LifeSM online program, which uses
Prevention evidence-based practices like individual goal-setting, social
The Quit For Life Program is the nations leading tobacco ces- support, and frequent logging of activity to help employees
sation program, offered by 27 states and more than 700 employers become more physically active on a regular basis
and health plans throughout the US. A collaboration between Tobacco Policy Planner, an online assessment of company
the American Cancer Society and Alere Health, the program is policies, benefits, and programs related to tobacco con-
built on the organizations more than 35 years of combined trol. Following the completion of the survey, the company
experience in tobacco cessation. The Quit For Life Program receives a detailed report that includes information needed
employs an evidence-based combination of physical, psycholog- to help create new or enhance existing workplace tobacco
ical, and behavioral strategies to enable participants to take policies, programs, and benefits. The resource can assist
responsibility for and overcome their addiction to tobacco. A employers in creating a safe, tobacco-free environment that
critical mix of medication support, phone-based cognitive enhances employee well-being.
behavioral coaching, text messaging, web-based learning, and
support tools produces an average 6-month quit rate of 49%.

Nutrition and Physical Activity Planner, an online assess- be tested. The Society also continues to encourage the early
ment of company policies, benefits, and programs related detection of breast cancer through public awareness and other
to eating better and being more physically active. Following efforts targeting poor and underserved communities.
the completion of the survey, the company receives a detailed
report that includes information needed to help create new-or Treatment
enhance existing workplace policies, programs and benefits. For the more than 1.6 million cancer patients diagnosed this
The Meeting Well guidebook, which offers companies year and the nearly 14.5 million US cancer survivors, the Ameri-
healthy food ideas and suggestions for physical activity that can Cancer Society is available 24 hours a day, seven days a week
energize meeting participants and demonstrate how easy it to provide among other things the latest cancer information,
can be to live a healthier lifestyle every day emotional support, or free lodging when patients need treat-
ment away from home.
For the majority of Americans who do not smoke, the most
important ways to reduce cancer risk are to maintain a healthy Information, 24 Hours a Day, 7 Days a Week
weight, be physically active on a regular basis, and eat a mostly The American Cancer Society is available 24 hours a day, 7 days
plant-based diet, consisting of a variety of vegetables and fruit, a week online at cancer.org and by calling 1-800-227-2345. Callers
whole grains, and limited amounts of red and processed meats. are connected with a cancer information specialist who can
The Society publishes guidelines on nutrition and physical activ- help them locate a hospital, understand cancer and treatment
ity for cancer prevention in order to review the accumulating options, learn what to expect and how to plan, address insur-
scientific evidence on diet and cancer; to synthesize this evi- ance concerns, find financial resources, find a local support
dence into clear, informative recommendations for the general group, and more. The Society can also help people who speak
public; to promote healthy individual behaviors and environ- languages other than English or Spanish find the assistance
ments that support healthy eating and physical activity; and, they need, offering services in more than 200 languages.
ultimately, to reduce cancer risk. Those guidelines form the
Information on every aspect of the cancer experience, from pre-
foundation for the Societys communication, worksite, school,
vention to survivorship, is also available through cancer.org, the
and community strategies designed to encourage and support
Societys website. The site contains in-depth information on
people in making healthy lifestyle behavior choices.
every major cancer type, as well as on treatments, side effects,
Early Detection caregiving, and coping.
Finding cancer at its earliest, most treatable stage gives patients The Society also publishes a wide variety of brochures and books
the greatest chance of survival. To help the public and health that cover a multitude of topics, from patient education, quality
care providers make informed decisions about cancer screen- of life, and caregiving issues to healthy living. Visit cancer.org/
ing, the American Cancer Society publishes a variety of early bookstore for a complete list of Society books that are available
detection guidelines. Those guidelines are assessed regularly to to order.
ensure that recommendations are based on the most current
scientific evidence. The Society publishes three peer-reviewed journals for health
care providers and researchers: Cancer, Cancer Cytopathology,
The Society currently provides screening guidelines for cancers and CA: A Cancer Journal for Clinicians. Visit acsjournals.com to
of the breast, cervix, colorectum, endometrium, lung, and pros- learn about the journals and their content.
tate, as well as general recommendations for a cancer-related
component of a periodic checkup to examine the thyroid, oral Day-to-day Help and Emotional Support
cavity, skin, lymph nodes, testicles, and ovaries. The American Cancer Society can help cancer patients and their
families find the resources they need to make decisions about
Throughout its history, the Society has implemented a number
the day-to-day challenges that can come from a cancer diagno-
of aggressive awareness campaigns targeting the public and
sis, such as transportation to and from treatment, financial and
health care professionals. Campaigns to increase usage of Pap
insurance needs, and lodging when treatment is needed away
testing and mammography have contributed to a 70% decrease
from home. The Society also connects people with others who
in cervical cancer death rates since 1969 and a 36% decline in
have been through similar experiences to offer emotional
breast cancer death rates since 1989. Building on previous and
support.
ongoing colorectal cancer prevention and early detection efforts,
the Society joined the National Colorectal Cancer Roundtable in Help navigating the health care system: Learning how to nav-
its 80% by 2018 initiative in 2013. The bold goal of this campaign igate the cancer journey and the health care system can be
is to increase the rate of regular colorectal cancer screening overwhelming for anyone, but it is particularly difficult for those
among adults 50 and older to 80% by 2018, with an emphasis on who are medically underserved, those who experience language
economically disadvantaged individuals, who are least likely to or health literacy barriers, and those with limited resources. The

American Cancer Society Patient Navigator Program reaches ing with family and friends, finding resources, and more. Visit
those most in need. The largest oncology-focused patient navi- cancer.org/icancope to learn more about the classes that are
gator program in the country, it has specially trained patient available.
navigators at more than 120 sites across the nation. Patient navi-
Hair-loss and mastectomy products: Some women wear wigs,
gators can help: find transportation to and from cancer-related
hats, breast forms, and special bras to help cope with the effects
appointments; assist with medical financial issues, including
of a mastectomy and hair loss. The American Cancer Society
insurance navigation; identify community resources; and pro-
tlc Tender Loving Care publication offers affordable hair loss
vide information on a patients cancer diagnosis and treatment
and mastectomy products, as well as advice on how to use those
process. In 2014, 56,000 people relied on the Patient Navigator
products. The tlcTM products and catalogs may be ordered
Program to help them through their diagnosis and treatment.
online at tlcdirect.org or by calling 1-800-850-9445. All proceeds
The Society collaborates with a variety of organizations, includ-
from product sales go back into the Societys survivorship pro-
ing the National Cancer Institutes Center to Reduce Cancer
grams and services.
Health Disparities, the Center for Medicare and Medicaid Ser-
vices, numerous cancer treatment centers, and others to Help with appearance-related side effects of treatment: The
implement and evaluate this program. Look Good Feel Better program is a collaboration of the Ameri-
can Cancer Society, the Personal Care Products Council
Transportation to treatment: Having cancer is hard. Finding a
Foundation, and the Professional Beauty Association that helps
ride to treatment shouldnt be. The American Cancer Society
women with cancer manage the appearance-related side effects
Road To Recovery program provides free rides to cancer
of treatment. The free program engages certified, licensed
patients to and from treatments and cancer-related appoint-
beauty professionals trained as Look Good Feel Better volun-
ments. Trained volunteer drivers donate their time and the use
teers to teach simple techniques on skin care, makeup, and nail
of their personal vehicles to help patients get to the treatments
care, and give practical tips on hair loss, wigs, and head cover-
they need. In 2014, the American Cancer Society provided more
ings. Information and materials are also available for men and
than 341,000 rides to cancer patients.
teens. To learn more, visit the Look Good Feel Better website at
Lodging during treatment: The American Cancer Society lookgoodfeelbetter.org or call 1-800-395-LOOK (1-800-395-5665).
Hope Lodge program provides free overnight lodging to patients
Finding hope and inspiration: People with cancer and their
and their caregivers who have to travel away from home for
loved ones do not have to face cancer alone. The American Can-
treatment. Not having to worry about where to stay or how to
cer Society Cancer Survivors Network is a free online community
pay for it allows patients to focus on whats important: getting
created by and for people living with cancer and their families.
well. In 2014, the 31 Hope Lodge locations provided more than
At csn.cancer.org, they can get and give support, connect with
276,000 nights of free lodging to 44,000 patients and caregivers
others, find resources, and tell their own story through personal
saving them $36 million in hotel expenses. Through its Hotel
expressions like music and art.
Partners Program, the Society also partners with local hotels
across the country to provide free or discounted lodging to Research
patients and their caregivers in communities without a Hope
Research is at the heart of the American Cancer Societys mis-
Lodge facility.
sion. For 70 years, the Society has been finding answers that save
Breast cancer support: Through the American Cancer Society lives from changes in lifestyle to new approaches in therapies
Reach To Recovery program, trained breast cancer survivor vol- to improving cancer patients quality of life. No single nongov-
unteers are matched to people facing or living with breast ernmental, not-for-profit organization in the US has invested
cancer. Program volunteers give cancer patients and their fam- more to find the causes and cures of cancer than the Society. We
ily members the opportunity to ask questions, talk about their relentlessly pursue the answers that help us understand how to
fears and concerns, and express their feelings. The Reach To prevent, detect, and treat all cancer types. We combine the
Recovery volunteers have been there, and they offer understand- worlds best and brightest researchers with the worlds largest,
ing, support, and hope. In 2014, the program assisted nearly oldest, and most effective community-based anticancer organi-
8,000 patients. zation to put answers into action.
Cancer education classes: The I Can Cope online educational The Societys comprehensive research program consists of
program is available free to people facing cancer and their fami- extramural grants, as well as intramural programs in epidemiol-
lies and friends. The program consists of self-paced classes that ogy, surveillance and health services research, behavioral
can be taken anytime, day or night. People are welcome to take research, economic and health policy research, and statistics
as few or as many classes as they like. Among the topics offered and evaluation. Intramural research programs are led by the
are information about cancer, managing treatments and side Societys own staff scientists.
effects, healthy eating during and after treatment, communicat-

Extramural Research Cancer Control and Prevention Research: This research pro-
The American Cancer Societys Extramural Research program gram focuses on the study of behaviors (of individuals, health
currently supports research and training in a wide range of can- care professionals, or health care systems) and how interven-
cer-related disciplines at more than 200 institutions. As of tions to change these behaviors or systems can reduce cancer
August 1, 2015, the Society is funding 816 research and training risk, help detect cancer early, better inform treatment decisions,
grants totaling more than $441 million. Grant applications are or improve the quality of life of patients and families. Special
solicited through a nationwide competition and are subjected to emphasis is placed on reducing disparities in disadvantaged
a rigorous external peer-review process, ensuring that only the groups.
most promising research is funded. The Society primarily funds
Health Professional Training in Cancer Control: The goals of
investigators early in their research careers, thus giving the best
this program are to encourage highly qualified individuals to
and the brightest a chance to explore cutting-edge ideas at a
enter careers in cancer prevention and control practice and to
time when they might not find funding elsewhere. The Extramu-
accelerate the application of research findings in this area.
ral Research department is comprised of six programs that span
Toward that end, this program provides grants in support of
areas from the most basic research to public policy.
nurses, physicians, and social workers to pursue training in can-
Molecular Genetics and Biochemistry of Cancer: This cer prevention and control programs that meet high standards
research program focuses on the genes involved in cancer and for excellence.
how alterations in those genes (mutations, deletions, and ampli-
In addition to funding across the continuum of cancer research
fications) play a role in the cancer process. Also of interest is the
and training, from basic science to clinical and quality-of-life
examination of molecules involved in cancer (proteins, nucleic
research, the Society also focuses on needs that are unmet by
acids, lipids, and carbohydrates) and how alterations in those
other funding organizations. For instance, for 10 years, the Soci-
molecules affect the disease. The program highlights potential
ety supported a targeted research program to address the causes
targets for new cancer treatments.
of higher cancer mortality in the poor and medically under-
Cancer Cell Biology and Metastasis: The primary goal of this served. To date, 47 Nobel Prize winners have received grant
program is to provide an understanding of the nature of cancer support from the Society, most of them early in their careers, a
cells so they can be more effectively detected and eliminated. number unmatched in the nonprofit sector and proof that the
Emphases include understanding the fundamental controls of organizations approach to funding young researchers truly
both normal cells and cancer cells, with a focus on how cells helps launch high-quality scientific careers.
regulate when to grow, when to divide and when to die; how and
when to develop from one cell type into another; how cells relate Intramural Research
to the local environment and to other cells; and how cells regu- In 1946, under the direction of E. Cuyler Hammond, ScD, a small
late when and how to move from one site to another. To reach the group of researchers was created at the American Cancer Soci-
program goals, a wide variety of cell and tumor types are uti- ety. Since that time, the Societys Intramural Research program
lized so that all aspects of cell biology can be examined. has grown into 5 programs that conduct and publish high-qual-
ity research to advance the understanding of cancer and
Preclinical and Translational Cancer Research: This evaluate Society programs to ensure that they are effective and
research program focuses on the interface between laboratory reaching the cancer patients that are most in need.
investigations and human testing. The scope of the program
includes investigations of the role of infectious diseases in can- Epidemiology: The Epidemiology Research program seeks
cer, the synthesis and discovery of cancer drugs, the creation to reduce the cancer burden by conducting large, nationwide
and use of cancer animal models, and the role of individual or prospective studies that advance our understanding of cancer
groups of genes in different types of cancer. etiology and survival to inform cancer prevention and control
programs, policies, and guidelines. To accomplish this work,
Clinical Cancer Research, Nutrition, and Immunology: This in 1952 Hammond pioneered the idea of working with the
program focuses on investigations including basic, preclinical, extensive network of Society volunteers nationwide to enroll
clinical, and epidemiological studies. Areas of interest include and follow large cohorts to provide insights into the causes of
new modalities for cancer prevention, diagnosis, and treatment. cancer. The first cohort, known as the Hammond-Horn Study,
In addition, the program seeks to improve understanding of was conducted from 1952 through 1955 and provided the first
cancer-related inflammatory responses and the use of the US prospective evidence to confirm the association between
immune system for cancer prevention and therapy. The program cigarette smoking and death from lung cancer, cardiovascular
also focuses on increased understanding of the effects of nutri- disease, and other conditions in men. The success of this early
tion and the environment on cancer prevention, initiation, study established the foundation on which the Society invested
progression, and treatment. in a series of large prospective studies the Cancer Prevention

Studies and in the creation and growth of the Epidemiology cohort is aging and a new cohort is essential to continue explor-
Research program. Indeed, with help from more than 150,000 ing the effects of changing exposures and to provide greater
Society volunteers to enroll and collect information from more opportunity to integrate biological and genetic factors into
than 2.2 million US men and women, findings from the Ham- studies of other cancer risk factors. Therefore, following on the
mond-Horn Study, Cancer Prevention Study-I (CPS-I, 1959-1972), long history of partnering with Society volunteers and support-
and CPS-II (1982-ongoing) have played a major role in cancer ers, CPS-3 was established. From 2006 through 2013, more than
prevention initiatives at the Society, as well as in other national 304,000 men and women, ages 30 to 65, were enrolled in CPS-3,
and international efforts. For example: and nearly all provided a blood sample at the time of enrollment.
The Hammond-Horn Study, which linked smoking to lung Although over the past decade very large cohorts have been
cancer and higher overall death rates, contributed to the established in some European and Asian countries, CPS-3 is the
Surgeon Generals landmark 1964 conclusion that smoking only nationwide study of this magnitude in the US. The blood
causes lung cancer and helped drive a decline in adult smok- specimens and questionnaire data collected from CPS-3 partici-
ing rates to less than 20% today. American Cancer Society pants will provide unique opportunities for research in the
epidemiologic studies continue to document the ongoing United States.
health impact of smoking. In 2014, the Surgeon General used Surveillance and Health Services Research: The Surveillance
our results to show that more than 480,000 Americans die and Health Services Research (SHSR) program analyzes and dis-
each year from smoking cigarettes. seminates data on cancer occurrence, risk factors, prevention,
CPS-I provided the first epidemiologic evidence that obesity early detection, treatment, and outcomes to strengthen the sci-
increases risk of premature death, and subsequent studies entific basis for cancer prevention and control nationally and
from CPS-II helped to establish the link between obesity and globally. Researchers in the SHSR program produce Cancer Facts
death from breast, colorectal, and other cancers. & Figures, published since 1951, and the accompanying Cancer
In the early 1990s, CPS-II was the first prospective study Statistics article, published in CA: A Cancer Journal for Clinicians
to find a link between regular aspirin use and lower risk of (cacancerjournal.com) since 1967. These publications are the most
colorectal cancer, a finding confirmed by many later studies. widely cited sources for cancer statistics and are available on the
These results opened the door to ongoing studies in the US Societys website at cancer.org/statistics and in hard copy from
and internationally to find out if aspirin might lower the risk Society Division offices.
of other cancers and to better understand the overall risks In addition, SHSR staff produces seven supplemental Cancer
and benefits of aspirin use. Facts & Figures reports with accompanying Cancer Statistics
Our studies showing that high red and processed meat articles. Some of these publications focus on a specific cancer
and alcohol intake, low physical activity, and longer sitting site (e.g., breast) or subpopulation (e.g., Hispanics). Cancer Pre-
time increase the risk of cancer or mortality have contrib- vention & Early Detection Facts & Figures provides the prevalence
uted to the scientific evidence used to develop the Societys of cancer risk factors and screening, along with Society recom-
Guidelines on Nutrition and Physical Activity for Cancer mendations, policy initiatives, and evidence-based cancer
Prevention. Moreover, findings from CPS-II were used to control programs. In addition, staff collaborates with the Inter-
demonstrate the lifesaving potential of a lifestyle consistent national Agency for Research on Cancer (IARC) to publish Global
with our guidelines. Cancer Facts & Figures, as well as joining with additional inter-
Findings from CPS-II contributed substantially to the scien- national collaborators to produce The Cancer Atlas.
tific evidence associating increasing levels of specific types Surveillance epidemiologists also conduct and publish high-
of air pollution with higher deaths rates from cardiovascular quality epidemiologic research in order to advance the
disease and lung cancer. These studies are cited prominently understanding of cancer. Since 1998, Society epidemiologists
by both the Environmental Protection Agency and World have collaborated with the National Cancer Institute, the Cen-
Health Organization in policies and recommendations for US ters for Disease Control and Prevention, the National Center for
and worldwide air pollution limits. Health Statistics, and the North American Association of Cen-
CPS-II data and biospecimens have been included in the tral Cancer Registries to produce the Annual Report to the
identification or validation of nearly every confirmed breast, Nation on the Status of Cancer, a highly cited, peer-reviewed
prostate, and pancreatic cancer genetic susceptibility variant journal article that reports current information related to can-
known to date. This work has led to a better understanding of cer rates and trends in the US. Other research topics include
the heritable component of these cancers. exploring socioeconomic, racial, and geographic disparities in
cancer risk factors, screening, and occurrence; describing global
While landmark findings from the CPS-II cohort have informed
cancer trends; generating scientific evidence to support Society
multiple areas of public health policy and clinical practice, this

priority areas for cancer prevention, control, and advocacy; and but economic solutions such as taxation and better trade and
demonstrating the association between public health interven- investment policies are also among the most effective and least
tions, such as tobacco control, and cancer incidence and expensive solutions. Major donors in global health, such as the
mortality. Recent surveillance studies have reported the identi- Bloomberg Philanthropies, the Bill & Melinda Gates Founda-
fication of colorectal cancer hotspots where death rates are tion, and the US National Institutes of Health, supported this
particularly high; an increase in colorectal cancer screening effort by granting the ITCR program additional funding.
among low-income individuals following the elimination of
Due to the high demand for the type of economic and policy anal-
cost-sharing for preventive services by the Affordable Care Act;
ysis generated by the ITCR program, the Societys leadership
the public health impact of achieving the 80% colorectal cancer
made a strategic decision in early 2013 to expand the program to
screening rate by 2018 among adults 50 and older; cancer death
the areas of nutrition and physical activity, and change its name
rates by US congressional district; and global patterns in smok-
to the EHPR program. Moreover, the team is increasingly apply-
ing related to tobacco control policies.
ing its expertise to a number of cancer-related challenges,
Health Services Research (HSR) activities began in the late including the economic and policy aspects of additional risk fac-
1990s, with the primary objective of performing high-quality, tors, patient access to potentially lifesaving medicines, and the
high-impact research to evaluate disparities in cancer treat- direct and indirect costs of cancer and its treatment. The dis-
ment and outcomes in support of the Societys mission to reduce semination of this research comes in multiple forms, including
health care inequalities. Researchers in the HSR program use publications in high-impact, peer-reviewed scientific journals;
secondary data sources such as the National Cancer Data Base the release of public scientific reports; and local, national, and
(NCDB), a hospital-based cancer registry jointly sponsored by international capacity-building programs with governments,
the American Cancer Society and the American College of Sur- international governmental organizations, and civil society.
geons. The NCDB has been key to the programs research on the
The flagship service publication of the EHPR program is The
impact of insurance on cancer diagnosis, treatment, and out-
Tobacco Atlas, which is produced in collaboration with the Soci-
comes, as well as for broader cancer treatment patterns. Other
etys Global Health department and the World Lung Foundation.
data sources include the SEER-Medicare database, a linkage of
The Tobacco Atlas, Fifth Edition and its corresponding website,
population-based cancer registry data with Medicare claims
tobaccoatlas.org, were released at the 16th World Conference on
data, and the Medical Expenditure Panel Survey Data linked
Tobacco or Health (WCTOH) in March 2015 in Abu Dhabi, United
with National Health Interview Survey Data. The findings from
Arab Emirates, and will be available in six other languages
the Health Services Research group have been instrumental in
French, Spanish, Portuguese, Chinese, Mandarin, and Arabic.
the Societys and the American Cancer Society Cancer Action
Networks (ACS CAN) support of the Affordable Care Act (ACA). Behavioral Research Center: The American Cancer Society
Recent studies include the effect of the ACA on receipt of preven- was one of the first organizations to recognize the importance of
tive services; the benefit of radiation therapy in the treatment of behavioral and psychosocial factors in the prevention and control
lymph node positive prostate cancer; racial disparities in treat- of cancer and to fund extramural research in this area. In 1995, the
ment and outcomes for men with early stage breast cancer; and Society established the Behavioral Research Center (BRC) within
treatment disparities associated with geographic distribution of the Intramural Research department. The BRCs work currently
oncologists and travel distance. focuses on cancer survivorship, quality of life, tobacco control,
and health disparities. The BRCs ongoing projects include:
Economic and Health Policy Research: The predecessor of the
Economic and Health Policy Research (EHPR) program, the Studies of the quality of life of cancer survivors, which include
International Tobacco Control Research (ITCR) program, was the American Cancer Society Study of Cancer Survivors-I
created in 2006 to support collaborative tobacco control efforts (SCS-I), a nationwide longitudinal study of a cohort of more
involving the Society and numerous international organizations than 3,000 cancer survivors that explores the physical and
and academic institutions such as the WHO Tobacco Free Initia- psychosocial adjustment to cancer and identifies factors
tive, the Centers for Disease Control and Prevention (CDC), the affecting quality of life. Results from this research have
Campaign for Tobacco-Free Kids, Johns Hopkins University, and informed the Societys informational materials and support
the University of Illinois, among others. The ITCR program programs for cancer patients, survivors, and their loved ones.
focused on economic and policy research in tobacco control and Studies of family caregivers, which include a nationwide
research capacity building for the collection and analysis of eco- longitudinal study of a cohort of more than 1,500 cancer care-
nomic data to provide the evidence base for tobacco control, givers that explores the impact of the familys involvement in
particularly in low- and middle-income countries. This was an cancer care on the quality of life of the cancer survivor and
important investment by the Society because not only do eco- the caregiver
nomic factors contribute greatly to the global tobacco epidemic,

A study of side effects of cancer treatment, such as pain, expertise and assistance are available to Society staff at the Cor-
fatigue, or depression, which often go underreported and/or porate Center in Atlanta, Georgia, and across the Societys 11
undertreated. Data from this collaboration between the Soci- geographic Divisions.
ety, the National Cancer Institute, and the American College
SEC staff designs and conducts process and outcome evalua-
of Surgeons could play an important role in improving symp-
tions of Society programs, projects, and initiatives using focus
tom control, which would ultimately lead to improvements in
groups, structured and semi-structured interviews, and online
quality of life, functioning, and treatment adherence.
surveys. The SEC continues to be engaged in evaluations of the
Studies to identify and prioritize gaps in information and Societys externally funded community-based cancer preven-
resources for 1,250 breast, colorectal, and prostate cancer tion initiatives. Working with the Societys Cancer Control
survivors as they transition from active treatment under the department, the SEC secured funding from the CDC to create a
care of the oncology team back to the community care set- national HPV roundtable and is providing evaluation and opera-
ting. Research results will inform interventions by the Society tional support to initiatives aimed at increasing HPV vaccination
and others by describing the issues cancer survivors continue rates among adolescents. The SEC also partners with the Behav-
to face after their treatment ends, the key variables that inter- ioral Research Center and the Societys Cancer Control
ventions should target, and the best time to intervene. department in the systematic evaluation of all Society survivor-
Studies investigating how social, psychological, and other ship and quality-of-life programs, in the development of
factors impact smokers motivation and ability to quit in guidelines for support of cancer survivors who have completed
order to improve existing Society programs for smoking ces- their cancer treatments, and in developing and evaluating fund-
sation (e.g., the Freshstart and the Great American Smokeout raising activities in support of these programs. The SEC has
programs) or to develop new technology-based interventions partnered with the Surveillance and Health Services Research
for smokers who seek cessation assistance program to further analyze the geographical distribution of
Contributions to the development of a National Cancer cancer and the needs of cancer patients with the goal of provid-
Survivorship Resource Center (cancer.org/survivorshipcenter), ing information in support of American Cancer Society mission
meant to advance survivorship as a distinct phase of cancer and advocacy programming. The SEC and SHSR recently com-
care, promote healthy behaviors to reduce long-term and late puted and published estimated mortality rates for selected
effects of cancer and its treatment, improve surveillance and cancer for each US congressional district.
screening practices to detect the return of cancer, and pro-
Advocacy
vide primary care clinicians with survivorship clinical care
guidelines for their patients with a history of breast, prostate, Conquering cancer is as much a matter of public policy as scien-
colorectal, or head and neck cancer tific discovery. Lawmakers play a critical role in determining
how much progress we make as a country to defeat cancer
Studies to better understand cancer prevention and control
whether its advocating for quality, affordable health care for all
behavior in underserved populations and identify effective
Americans, increasing funding for cancer research and pro-
strategies for connecting these groups to cancer information,
grams, improving quality of life for patients and their families,
programs, and services
or enacting laws and policies that help communities to promote
Research to identify, test, and disseminate evidence-based good health. The American Cancer Society Cancer Action Net-
behavioral interventions that are appropriate and effective for work (ACS CAN), the Societys nonprofit, nonpartisan advocacy
underserved populations to help achieve cancer health equity affiliate, works with elected officials to achieve these goals.
Statistics and Evaluation Center: The mission of the Statistics Created in 2001, ACS CAN is the force behind a powerful grass-
and Evaluation Center (SEC) is to deliver valid, reliable, accu- roots movement uniting and empowering cancer patients,
rate, and timely information to American Cancer Society staff survivors, caregivers, and their families to fight back against
for evidence-based decision making that ensures the Society cancer. As the nations leading voice advocating for public poli-
continues to provide effective, high-quality programs. Staffed by cies that are helping to defeat cancer, ACS CAN works to
professional statisticians and evaluators, the SEC has 3 main encourage elected officials and candidates to make the fight
responsibilities: 1) to provide leadership on evaluations of Soci- against cancer a top national priority. In recent years, ACS CAN
ety mission and income delivery programs, including study has successfully worked to pass and implement laws at the fed-
design, data analysis, and report preparation; 2) to provide oper- eral, state, and local levels that: assure cancer patients access to
ational support for surveys and other data collection related to adequate and affordable health insurance coverage, increase
Society constituents and consumers; and 3) to support the funding for groundbreaking cancer research; improve access to
broader Society mission through information integration, prevention and early detection measures, treatment, and follow-
including mapping and return on investment studies. SEC up care; and improve quality of life for cancer patients.

Some of ACS CANs recent advocacy accomplishments on behalf is now working to expedite full implementation of the law,
of cancer patients are outlined in the following sections. including the regulation of new and emerging products.
Leading efforts to pass comprehensive smoke-free laws cur-
Access to Care
rently covering about half of the US population including
ACS CAN successfully advocated for the enactment of key
24 states, the District of Columbia, Puerto Rico, the US Virgin
patient protections in the Affordable Care Act (ACA) that elimi-
Islands, and countless local jurisdictions requiring all work-
nated insurance coverage exclusions, prevented pre-existing
places, restaurants, and bars to be smoke-free
condition exclusions, eliminated caps on annual and lifetime
coverage benefits, and removed copays for key cancer preventive Working to increase federal and state taxes on all tobacco
services and early detection screenings like mammography and products and defending against tax rollbacks. The average
colonoscopy. The legislation also required coverage of routine state tax rate for cigarettes rose from $1.54 at the end of 2014
care for participants in clinical trials, and created a new dedi- to $1.60 in 2015 (current as of September 2015)
cated Prevention and Public Health Fund, providing billions of Working to increase and protect state funding for tobacco
dollars each year for national and community-based prevention control programs
efforts. Finally, the legislation provided for the expansion of Continuing its role as an intervener in the long-pending
Medicaid to cover low-income individuals and families who pre- legal review of the federal governments lawsuit against the
viously lacked any access to affordable insurance coverage. tobacco industry, in which specific manufacturers were
The organization continues to monitor implementation of this convicted under the Racketeer Influenced and Corrupt Orga-
important law to ensure: nizations statute for decades of fraudulent practices aimed at
addicting generations of smokers to their deadly products.
Continuation of the Prevention and Public Health Fund
Continuing to support implementation of the Healthy,
Continued expansion of Medicaid in all 50 states in the face Hunger-Free Kids Act of 2010, important legislation to reau-
of a 2012 Supreme Court ruling making the expansion a thorize the federal child nutrition programs and strengthen
state-by-state option school nutrition
Passage of state legislation to ensure cost-sharing for chemo- Advocating for state and local requirements to increase the
therapy and other vital treatment options are affordable to quality and quantity of physical education and physical
patients activity in K-12 schools and hold schools accountable for
Full public access to health plan information for consumers increasing students physical activity and fitness
shopping for health insurance coverage Supporting the federal governments development of the 2015
Full federal funding for community health centers, which edition of the Dietary Guidelines for Americans, which forms
provide community-oriented primary care in areas that are the basis of all federal nutrition policies and programs, and
underserved or do not have access to other health care services helping to ensure it reflects the current science linking diet
and cancer risk
Funding the Research
Advocating for science-based updates to the Nutrition Facts
ACS CAN is a leader in the effort to ensure full funding for the
label that appears on most packaged foods and beverages
nations public cancer research institutions, including the
National Institutes of Health and its National Cancer Institute. Supporting the implementation of menu labeling in restau-
Each year, nearly $5 billion in grant funding for cancer research rants and other food retail establishments
is distributed to investigators working in cancer centers, univer- Working with states to pass legislation prohibiting minors
sities, and labs in every state of the country. Federal budget from accessing indoor tanning devices
pressures threaten this funding every year, and ACS CAN views Advocating for coverage of cancer screenings and other
protection of this account to be of prime importance in the recommended preventive services without financial barriers
search for cures. in private insurance, Medicare, and Medicaid
Prevention and Early Detection Advocating for full funding for the National Breast and
ACS CAN is supporting legislation that focuses on the preven- Cervical Cancer Early Detection Program and the Colorectal
tion and early detection of cancer by: Cancer Control Program, which provides free evidence-based
cancer screenings and treatment to low-income, uninsured,
Leading the advocacy partnership that pushed the 2009
and medically underserved men and women
enactment of the Family Smoking Act giving the US Food and
Drug Administration authority, for the first time, to regulate Supporting a federal bill to eliminate an unexpected cost-
the production and marketing of tobacco products. ACS CAN sharing requirement imposed on Medicare beneficiaries who
have a polyp removed during colonoscopy.

Quality of Life cancer community is heard in the halls of government and is
ACS CAN supports balanced pain policies at the federal and empowering communities everywhere to fight back.
state levels that ensure continued patient and survivor access
Another way that the American Cancer Society is championing
to the pain relief medications that they need to live and work
the cause of the cancer community is through our Relay For Life
independently and have good quality of life.
and Making Strides Against Breast Cancer programs. The Relay
ACS CAN supports the enactment of legislation that would For Life movement is the worlds largest grassroots fundraising
assure cancer patients full access to palliative care services, event to end every cancer in every community. Rallying the pas-
along with curative treatment, from the point of diagno- sion of four million people worldwide, Relay For Life events raise
sis through treatment and survivorship or end of life as critical funds that help fuel the mission of the Society, an organi-
the case may be. Palliative care for pain and symptoms of zation whose reach touches so many lives those who are
treatment has been shown to improve patient, survivor, and currently battling cancer, those who may face a diagnosis in the
family quality of life and in some cases improves survival future, and those who may avoid a diagnosis altogether thanks
for cancer patients. The legislation provides for increased to education, prevention, and early detection. The Making
training and professional development in palliative care, a Strides Against Breast Cancer walk is a powerful event to raise
nationwide public and provider education campaign to dis- awareness and funds to end breast cancer. It is the largest net-
seminate information about the benefits of palliative care, work of breast cancer events in the nation, uniting nearly 300
and additional research into the biologic bases of pain, and communities to finish the fight. The walks raise critical funds
other symptoms such as breathlessness, fatigue, and cogni- that enable the Society to fund groundbreaking breast cancer
tive impairment, for which there are few treatment options research; provide free comprehensive information and services
available today. ACS CAN has worked to mitigate the public to patients, survivors, and caregivers; and ensure access to
impact of cancer drug shortages that periodically plague the mammograms for women who need them so more lives are saved.
industry. The organization is making sure the voice of the
Sources of Statistics
Estimated new cancer cases in 2016. The number of new can- period divided by the number of people who were at risk for the
cer cases in the US in 2016 was projected using a spatiotemporal disease in the population. Incidence rates in this publication are
model based on incidence data from 49 states and the District of presented per 100,000 people and are age adjusted to the 2000
Columbia for the years 1998-2012 that met the North American US standard population to allow comparisons across popula-
Association of Central Cancer Registries (NAACCR) high-qual- tions with different age distributions. State-, race-, and
ity data standard for incidence. This method considers ethnicity-specific incidence rates were previously published in
geographic variations in sociodemographic and lifestyle factors, NAACCRs publication Cancer Incidence in North America, 2008-
medical settings, and cancer screening behaviors as predictors 2012. (See B in Additional information on page 65 for full
of incidence, and also accounts for expected delays in case reference.)
reporting. (For more information on the estimation of new inva-
Trends in cancer incidence rates provided in this publication are
sive cases, see A in Additional information on page 65.)
based on delay-adjusted incidence rates from registries in the
The number of new cases among Asian Americans, Native National Cancer Institutes Surveillance, Epidemiology, and End
Hawaiians, and Pacific Islanders (AANHPIs), as well as those for Results (SEER) program. Delay-adjustment accounts for delays
female breast carcinoma in situ and melanoma in situ, were esti- and error corrections that occur in the reporting of cancer cases,
mated by projecting the average annual percent change in the which is substantial for some sites, particularly those less often
estimated number of cases during the most recent 10 years of diagnosed in a hospital, such as leukemia. Delay-adjustment is
data (2003-2012) to 2016. Cases from 2003 through 2012 were not available for some cancer types. Trends were originally pub-
estimated by applying age-specific incidence rates from 44 lished in the SEER Cancer Statistics Review (CSR) 1975-2012. (See
states and the District of Columbia to population counts. Esti- C in Additional information on page 65 for full reference.)
mates for AANHPIs were adjusted for delays in case reporting.
Estimated cancer deaths in 2016. The estimated number of US
Delay adjustment was unavailable for in situ breast and in situ
cancer deaths was calculated by fitting the number of cancer
melanoma estimates.
deaths from 1998 to 2012 to a statistical model that forecasts the
Incidence rates. Incidence rates are defined as the number of number of deaths expected to occur in 2016. The estimated
people who are diagnosed with cancer during a given time number of cancer deaths for each state was calculated similarly

using state-level data. For both US and state estimates, data on information for full references.) One-year survival rates were
the number of deaths were obtained from the National Center based on cancer patients diagnosed from 2008 to 2011, 10-year
for Health Statistics (NCHS) at the Centers for Disease Control survival rates were based on diagnoses from 1999 to 2011, and
and Prevention. (For more information on this method, see D 15-year survival rates were based on diagnoses from 1994 to
in Additional information.) 2011; all patients were followed through 2012.
Mortality rates. Mortality rates, or death rates, are defined as Probability of developing cancer. Probabilities of developing
the number of people who die from cancer during a given year cancer were calculated using DevCan (Probability of Developing
divided by the number of people at risk in the population. In this Cancer) software version 6.7.3, developed by the National Cancer
publication, mortality rates are based on counts of cancer Institute. (See F in Additional information for full reference.)
deaths compiled by the NCHS and population data from the US These probabilities reflect the average experience of people in
Census Bureau. Death rates in this publication are presented per the US and do not take into account individual behaviors and
100,000 people and are age adjusted to the 2000 US standard risk factors. For example, the estimate of 1 man in 14 developing
population to allow comparisons across populations with differ- lung cancer in a lifetime underestimates the risk for smokers
ent age distributions. These rates should be compared only to and overestimates the risk for nonsmokers.
other statistics that are age adjusted to the US 2000 standard
Additional information. More information on the methods
population. Trends in cancer mortality rates provided for
used to generate the statistics for this report can be found in the
selected cancer sites were based on mortality data from 1975 to
following publications:
2012 and were first published in the CSR 1975-2012. (See C in
Additional information for full reference.) A. Zhu L, Pickle LW, Naishadham D, et al. Predicting US and
state-level cancer counts for the current calendar year: part II
Important note about estimated cancer cases and deaths
evaluation of spatio-temporal projection methods for incidence.
for the current year. The methodology for the 4-years-ahead
Cancer 2012;118(4): 1100-9.
projection of new cancer cases and deaths is model-based and is
updated over time as we continually strive to achieve the most B. Copeland G, Lake A, Firth R, et al. (eds). Cancer in North Amer-
accurate estimates. As a result, the numbers may vary from year ica: 2008-2012. Volume Two: Registry-specific Cancer Incidence in
to year for reasons other than changes in cancer occurrence. the United States and Canada. Springfield, IL: North American
Therefore, these estimates should be interpreted with the under- Association of Central Cancer Registries, Inc. June 2015. Avail-
standing that they provide a reasonably accurate portrayal of able at naaccr.org/DataandPublications/CINAPubs.aspx.
the current cancer burden, but cannot be used to track year-to-
C. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer
year changes in cancer occurrence. Age-adjusted incidence and
Statistics Review, 1975-2012. National Cancer Institute. Bethesda,
mortality rates reported by the SEER program and the NCHS,
MD, 2015. Available at seer.cancer.gov.
respectively, are the preferred statistics to track cancer trends in
the US. Rates from state cancer registries are useful for tracking D. Chen HS, Portier K, Ghosh K, et al. Predicting US and State-
local trends. level counts for the current calendar year: part I evaluation of
temporal projection methods for mortality. Cancer 2012;118(4):
Survival. This report presents relative survival rates for whites,
1091-9.
blacks, and all races combined to describe cancer survival. Rela-
tive survival adjusts for normal life expectancy by comparing E. SEER 18 database: Surveillance, Epidemiology, and End
survival among cancer patients to that of people not diagnosed Results (SEER) Program (seer.cancer.gov) SEER*Stat Data- base:
with cancer who are of the same age, race, and sex. Cause-spe- Incidence SEER 18 Regs Research Data + Hurricane Katrina
cific survival is used for AANHPIs due to data limitations and Impacted Louisiana Cases, Nov 2014 Sub (1973-2012 varying)
should not be compared to relative survival statistics. Five-year Linked To County Attributes Total U.S., 1969-2013 Counties,
survival statistics presented in this publication were originally National Cancer Institute, DCCPS, Surveillance Research Pro-
published in CSR 1975-2012, with all patients followed through gram, Cancer Statistics Branch, released April 2015, based on
2012. Trends in survival are based on data from the nine oldest the November 2014 submission. SEER*Stat software: Surveil-
SEER registries, which go back to 1975, whereas all other sur- lance Research Program, National Cancer Institute SEER*Stat
vival rates are based on data from all 18 SEER registries, which software (seer.cancer.gov/seerstat) version 8.2.1.
provide greater population coverage. In addition to 5-year rela-
F. DevCan: Probability of Developing or Dying of Cancer Soft-
tive survival rates, 1-, 10-, and 15-year survival rates are
ware, Version 6.7.3; Statistical Research and Applications
presented for selected cancer sites. These survival rates were
Branch, National Cancer Institute, April 2015. http://srab.cancer.
generated using the National Cancer Institutes SEER 18 data-
gov/devcan.
base and SEER*Stat software version 8.2.1. (See E in Additional

American Cancer Society Recommendations for the Early Detection of
Cancer in Average-risk Asymptomatic People*
Cancer Site Population Test or Procedure Recommendation
Breast Women, Mammography Women should undergo regular screening mammography starting at age 45 years.
ages 40-54 Women ages 45 to 54 should be screened annually.
Women should have the opportunity to begin annual screening between the ages of 40 and 44.
Women, Transition to biennial screening, or have the opportunity to continue annual screening.
ages 55+ Continue screening as long as overall health is good and life expectancy is 10+ years.
Cervix Women, Pap test Screening should be done every 3 years with conventional or liquid-based Pap tests.
ages 21-29
Women, Pap test & HPV DNA test Screening should be done every 5 years with both the HPV test and the Pap test (preferred),
ages 30-65 or every 3 years with the Pap test alone (acceptable).
Women, Pap test & HPV DNA test Women ages 66+ who have had 3 consecutive negative Pap tests or 2 consecutive negative
ages 66+ HPV and Pap tests within the past 10 years, with the most recent test occurring in the past 5
years should stop cervical cancer screening.
Women who Stop cervical cancer screening.

have had a total
hysterectomy
Colorectal Men and Guaiac-based fecal occult Annual testing of spontaneously passed stool specimens. Single stool testing during a clinician
women, blood test (gFOBT) with office visit is not recommended, nor are throw in the toilet bowl tests. In comparison with
ages 50+ at least 50% sensitivity guaiac-based tests for the detection of occult blood, immunochemical tests are more patient-
or fecal immunochemical friendly and are likely to be equal or better in sensitivity and specificity. There is no justification
test (FIT) with at least 50% for repeating FOBT in response to an initial positive finding.
sensitivity, OR
Stool DNA test, OR Every 3 years
Flexible sigmoidoscopy Every 5 years alone, or consideration can be given to combining FSIG performed every 5
(FSIG), OR years with a highly sensitive gFOBT or FIT performed annually.
Double-contrast Every 5 years

barium enema, OR
Colonoscopy, OR Every 10 years
CT Colonography Every 5 years
Endometrial Women at Women should be informed about risks and symptoms of endometrial cancer and encouraged
menopause to report unexpected bleeding to a physician.
Lung Current or Low-dose helical CT Clinicians with access to high-volume, high-quality lung cancer screening and treatment centers
former smokers (LDCT) should initiate a discussion about annual lung cancer screening with apparently healthy patients
ages 55-74 in ages 55-74 who have at least a 30 pack-year smoking history, and who currently smoke or have
good health quit within the past 15 years. A process of informed and shared decision making with a clinician
with 30+ pack- related to the potential benefits, limitations, and harms associated with screening for lung cancer
year history with LDCT should occur before any decision is made to initiate lung cancer screening. Smoking
cessation counseling remains a high priority for clinical attention in discussions with current
smokers, who should be informed of their continuing risk of lung cancer. Screening should not
be viewed as an alternative to smoking cessation
Prostate Men, Prostate-specific antigen Men who have at least a 10-year life expectancy should have an opportunity to make an
ages 50+ test with or without digital informed decision with their health care provider about whether to be screened for prostate
rectal examination cancer, after receiving information about the potential benefits, risks, and uncertainties
associated with prostate cancer screening. Prostate cancer screening should not occur without
an informed decision-making process.
CT-Computed tomography. *All individuals should become familiar with the potential benefits, limitations, and harms associated with cancer screening. All positive tests
(other than colonoscopy) should be followed up with colonoscopy.

Geographic Divisions of the American Cancer Society, Inc.
To reach the American Cancer Society, please call 1-800-227-2345.
California Division Great West Division Midwest Division

1710 Webster Street (AK, AZ, CO, ID, MT, ND, NM, (IA, MN, SD, WI)
Oakland, CA 94612-3412 NV, OR, UT, WA, WY) 950 Blue Gentian Road
1313 Broadway Suite 100
East Central Division
Suite 100 Eagan, MN 55121-1577
(OH, PA)
Tacoma, WA 98402-3400
Route 422 and Sipe Avenue New England Division
PO Box 897 High Plains Division (CT, ME, MA, NH, RI, VT)
Hershey, PA 17033-0897 (GU, HI, KS, MO, NE, OK, TX) 30 Speen Street
2433 Ridgepoint Drive Framingham, MA 01701-9376
Eastern Division
Austin, TX 78754-5231
(NJ, NY) South Atlantic Division
132 West 32nd Street Lakeshore Division (DE, GA, MD, NC, SC, VA,
New York, NY 10001 (IL, IN, MI) Washington, DC, WV)
1755 Abbey Road 250 Williams Street
Florida Division
East Lansing, MI 48823-1907 Atlanta, GA 30303-1002
(including Puerto Rico
operations) Mid-South Division
3709 West Jetton Avenue (AL, AR, KY, LA, MS, TN)
Tampa, FL 33629-5146 1100 Ireland Way
Suite 300
Puerto Rico
Birmingham, AL 35205-7014
Urb. La Merced
Calle Cabo Alverio #577
Esquina Sargento Medina
Hato Rey, PR 00918
Acknowledgments
The production of this report would not have been possible without the efforts of: Rick Alteri, MD; Tracie
Bertaut, APR; Durado Brooks, MD, MPH; William Chambers, PhD; Ellen Chang, ScD; Moon S. Chen, Jr., PhD,
MPH; Sally Cowal, MPA; Dennis Deapen, DrPH, MPH; Carol DeSantis, MPH; Colleen Doyle, MS, RD; Jeffrey
Drope, PhD; Stacey Fedewa, MPH; Ted Gansler, MD, MBA; Susan Gapstur, PhD; Mia Gaudet, PhD; Ann
Goding-Sauer, MSPH; Scarlett Lin Gomez, PhD, MPH; Brenda Y. Hernandez, PhD, MPH; Eric Jacobs, PhD;
Marjorie Kagawa-Singer, RN, PhD; Debbie Kirkland; Lihua Liu, PhD, MS; Joannie Lortet-Tieulent, MSc;
Melissa Maitin-Shepard, MPP; Ann McMikel, MA; Anne-Michelle Noone, MS; Meg OBrien, PhD; Anthony
Piercy; Paulo Pinheiro, MD, PhD; Ken Portier, PhD; Debbie Saslow, PhD; Scott Simpson; Robert Smith, PhD;
Kevin Stein, PhD; Lindsey Torre, MSPH; Dana Wagner; Sophia Wang, PhD; Elizabeth Ward, PhD; Martin
Weinstock, MD; and Joe Zou.
Cancer Facts & Figures is an annual publication of the American Cancer Society, Atlanta, Georgia.
For more information, contact:
Rebecca Siegel, MPH; Kimberly Miller, MPH; or Ahmedin Jemal, DVM, PhD
Surveillance and Health Services Research Program
2016, American Cancer Society, Inc.
No. 500816

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Cancer Facts

Special Section: Cancer in Asian Americans,

Special Section: Cancer in Asian Americans,

Nutrition & Physical Activity 47

The Global Fight against Cancer 53

The American Cancer Society 55

Corporate Center: American Cancer Society Inc.

This publication attempts to summarize current scientific information about cancer.

Who Is at Risk of Developing Cancer?

Cancer Facts&Figures 20161

Lung & bronchus

2Cancer Facts&Figures 2016

Lung & bronchus

Cancer Facts&Figures 20163

Both sexes Male Female Both sexes Male Female

4Cancer Facts&Figures 2016

Cancer Facts&Figures 20165

6Cancer Facts&Figures 2016

Cancer Facts&Figures 20167

8Cancer Facts&Figures 2016

Cancer Facts&Figures 20169

Estimated New Cases Estimated Deaths

10Cancer Facts&Figures 2016

Cancer Facts&Figures 201611

12Cancer Facts&Figures 2016

Cancer Facts&Figures 201613

14Cancer Facts&Figures 2016

Cancer Facts&Figures 201615

16Cancer Facts&Figures 2016

Cancer Facts&Figures 201617

18Cancer Facts&Figures 2016

Cancer Facts&Figures 201619

20Cancer Facts&Figures 2016

Cancer Facts&Figures 201621

22Cancer Facts&Figures 2016

Cancer Facts&Figures 201623

24Cancer Facts&Figures 2016

Cancer Facts&Figures 201625

Nativity and citizenship (%)

Foreign-born, naturalized citizen 34 36 34 34 47 35 8 38 36 27 34 1 5

Foreign-born, not a citizen 25 25 17 34 16 26 17 25 17 12 15 1 4

Language spoken at home and

Only English spoken at home 31 26 46 24 17 32 68 16 25 12 26 89 58

Non-English at home, English

Educational attainment (%)

Less than high school graduate 14 18 7 9 29 7 5 13 35 33 31 9 12

High school graduate 16 15 16 9 22 18 19 15 25 23 30 36 37

Some college or associate's degree 21 16 31 11 23 22 29 18 25 28 26 35 37

Bachelor's degree or higher 29 26 37 32 19 34 31 30 12 13 10 14 10

AANHPI = Asian American, Native Hawaiian, and Pacific Islander.

26Cancer Facts&Figures 2016

Cancer Facts&Figures 201627

Heart diseases 2 12,266 21.8 92.0 1 481,991 23.9 171.2

Cerebrovascular diseases 3 4,108 7.3 30.8 4 100,154 5.0 35.5

Accidents (unintentional injuries) 4 2,372 4.2 15.0 5 99,288 4.9 43.7

Diabetes 5 2,158 3.8 15.7 7 50,443 2.5 18.5

Influenza and pneumonia 6 1,745 3.1 13.9 8 40,460 2.0 14.3

Alzheimer's disease 8 1,379 2.4 11.6 6 72,772 3.6 24.9

Suicide 9 1,152 2.0 6.2 9 33,727 1.7 15.7

All causes 56,352 100.0 406.1 2,016,896 100.0 742.3

28Cancer Facts&Figures 2016

Estimated New Cases Estimated Deaths

Cancer Facts&Figures 201629